Provider Demographics
NPI:1710444609
Name:SCHROEDER, KOURTNEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KOURTNEY
Middle Name:
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 1:8789 SAN JOSE BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4282
Mailing Address - Country:US
Mailing Address - Phone:904-383-1038
Mailing Address - Fax:
Practice Address - Street 1:8789 SAN JOSE BLVD STE 305
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4282
Practice Address - Country:US
Practice Address - Phone:904-383-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11482103TC0700X, 103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program