Provider Demographics
NPI:1457843559
Name:SCHROEDER, CALLIE (PSYD)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MARITIME DR
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2922
Mailing Address - Country:US
Mailing Address - Phone:920-769-0152
Mailing Address - Fax:920-769-0153
Practice Address - Street 1:1020 MARITIME DR
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2922
Practice Address - Country:US
Practice Address - Phone:920-769-0152
Practice Address - Fax:920-769-0153
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6923104100000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3632OtherWI LICENSE