Provider Demographics
NPI:1891758736
Name:SCHRADER, MONIQUE F (MALPC)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:F
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:MALPC
Other - Prefix:MS
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MALPC
Mailing Address - Street 1:16942 HOLIDAY CIR
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-3529
Mailing Address - Country:US
Mailing Address - Phone:660-882-2333
Mailing Address - Fax:660-882-2333
Practice Address - Street 1:15899 LOGANS LAKE RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-2866
Practice Address - Country:US
Practice Address - Phone:660-882-2333
Practice Address - Fax:660-882-2333
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005038682101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1538204904OtherBOONVILLE LOCATION NPI
MO1649269622OtherBILLING NPI