Provider Demographics
NPI:1871839936
Name:JACOBS-SCHROEDER, AMY LOVE (BA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOVE
Last Name:JACOBS-SCHROEDER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3195 ZINFANDEL DR., BUILDING G-#21
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-716-2822
Mailing Address - Fax:916-731-5576
Practice Address - Street 1:3195 ZINFANDEL DR
Practice Address - Street 2:BLDG G #21
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6376
Practice Address - Country:US
Practice Address - Phone:916-716-2822
Practice Address - Fax:916-731-5576
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician