Provider Demographics
NPI:1629116199
Name:SCHROEDER, JACKE LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACKE
Middle Name:LYNN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 SW QUAIL POST RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6367
Mailing Address - Country:US
Mailing Address - Phone:503-777-1366
Mailing Address - Fax:
Practice Address - Street 1:9920 SW QUAIL POST RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6367
Practice Address - Country:US
Practice Address - Phone:503-777-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL34011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical