Provider Demographics
NPI:1972741676
Name:SCHROEDER, LEANNE M (LAC)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:M
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7745 EAST PASADENA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212
Mailing Address - Country:US
Mailing Address - Phone:480-969-3800
Mailing Address - Fax:
Practice Address - Street 1:4250 E FLORIAN AVE
Practice Address - Street 2:BLDG #2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2797
Practice Address - Country:US
Practice Address - Phone:480-222-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC 11691101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor