Provider Demographics
NPI:1710432414
Name:SCHROEDER, DANIELLE (RD, LD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3827
Mailing Address - Country:US
Mailing Address - Phone:636-575-5831
Mailing Address - Fax:
Practice Address - Street 1:4223 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3827
Practice Address - Country:US
Practice Address - Phone:636-575-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016030007133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered