Provider Demographics
NPI:1295835437
Name:SCHROEDER, JOHN DEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DEAN
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:SCHROEDER TRUST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:589 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5604
Mailing Address - Country:US
Mailing Address - Phone:530-621-4890
Mailing Address - Fax:530-621-2425
Practice Address - Street 1:589 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5604
Practice Address - Country:US
Practice Address - Phone:530-621-4890
Practice Address - Fax:530-621-2425
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11026103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical