Provider Demographics
NPI:1467164384
Name:SCHROEDER, JIMENA DEL CARPIO (MED)
Entity Type:Individual
Prefix:
First Name:JIMENA
Middle Name:DEL CARPIO
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3081
Mailing Address - Country:US
Mailing Address - Phone:701-501-7449
Mailing Address - Fax:
Practice Address - Street 1:3220 4TH ST E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3081
Practice Address - Country:US
Practice Address - Phone:701-501-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1031-10-1-19101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty