Provider Demographics
NPI:1225587744
Name:SHRADER, KADOTTIE MIRIAM (LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:KADOTTIE
Middle Name:MIRIAM
Last Name:SHRADER
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:KADOTTIE
Other - Middle Name:MIRIAM
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHCA
Mailing Address - Street 1:4411 WASHINGTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:786-878-9009
Mailing Address - Fax:812-479-5014
Practice Address - Street 1:4411 WASHINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714
Practice Address - Country:US
Practice Address - Phone:812-479-1916
Practice Address - Fax:812-479-5014
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health