Provider Demographics
NPI:1891012555
Name:SCHNEIDER, JILLIAN (PHD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5509
Mailing Address - Country:US
Mailing Address - Phone:571-231-1210
Mailing Address - Fax:703-806-4079
Practice Address - Street 1:5980 9TH ST
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5509
Practice Address - Country:US
Practice Address - Phone:571-231-1210
Practice Address - Fax:703-806-4079
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
VA0810003921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical