Provider Demographics
NPI:1376775692
Name:SCHROEDER, JENNIFER (MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:1666 N MAIN ST
Mailing Address - Street 2:400
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-7417
Mailing Address - Country:US
Mailing Address - Phone:714-450-4173
Mailing Address - Fax:
Practice Address - Street 1:1666 N MAIN ST
Practice Address - Street 2:400
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-7417
Practice Address - Country:US
Practice Address - Phone:714-450-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health