Provider Demographics
NPI:1548757412
Name:SCHROEDER, KATHLEEN E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:E
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 1:890 E LA COSTA PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-6947
Mailing Address - Country:US
Mailing Address - Phone:630-362-0452
Mailing Address - Fax:
Practice Address - Street 1:4374 E BUTTE AVE.
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-8513
Practice Address - Country:US
Practice Address - Phone:520-868-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009016103TC0700X
AZ4665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical