Provider Demographics
NPI:1720577984
Name:SCHROEDER, CODY DEAN
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:DEAN
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19580 HIGHLAND OAKS DR APT 213
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9623
Mailing Address - Country:US
Mailing Address - Phone:605-215-7691
Mailing Address - Fax:
Practice Address - Street 1:19580 HIGHLAND OAKS DR APT 213
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9623
Practice Address - Country:US
Practice Address - Phone:605-215-7691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst