Provider Demographics
NPI:1154680023
Name:SCHROEDER, RYAN (PSYD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N KANSAS ST
Mailing Address - Street 2:SUITE3054
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3124
Mailing Address - Country:US
Mailing Address - Phone:316-293-3429
Mailing Address - Fax:316-293-1882
Practice Address - Street 1:7829 E ROCKHILL ST
Practice Address - Street 2:STE. 105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3920
Practice Address - Country:US
Practice Address - Phone:316-293-3850
Practice Address - Fax:316-683-6733
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2027103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist