Provider Demographics
NPI:1639185861
Name:SCHROEDER, LYNN M (LLP)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:M
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:PICKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP
Mailing Address - Street 1:1501 KRAFFT RD
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3565
Mailing Address - Country:US
Mailing Address - Phone:810-985-5125
Mailing Address - Fax:810-985-5127
Practice Address - Street 1:1501 KRAFFT RD
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3565
Practice Address - Country:US
Practice Address - Phone:810-985-5125
Practice Address - Fax:810-985-5127
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010996103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI139863PYOtherCARE CHOICES HMO
MILS010996OtherBLUE CROSS BLUE SHIELD MI