Provider Demographics
NPI:1205978681
Name:SCHRODER, KERRI STEPHANIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KERRI
Middle Name:STEPHANIE
Last Name:SCHRODER
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 1:2226 S AIRPORT RD W
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4706
Mailing Address - Country:US
Mailing Address - Phone:231-947-2442
Mailing Address - Fax:231-947-2446
Practice Address - Street 1:2226 S AIRPORT RD W
Practice Address - Street 2:SUITE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4706
Practice Address - Country:US
Practice Address - Phone:231-947-2442
Practice Address - Fax:231-947-2446
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007993103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B81206OtherBCBS
MI900002404OtherPRIORITY HEALTH VENDOR #
MI037258OtherVALUOPTIONS
MI0B84517Medicare PIN