Provider Demographics
NPI:1215239678
Name:ICE SCHROEDER, KRISTEN NOEL (LAC)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:NOEL
Last Name:ICE SCHROEDER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:NOEL
Other - Last Name:ICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:12563 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3427
Mailing Address - Country:US
Mailing Address - Phone:440-878-9800
Mailing Address - Fax:440-878-9804
Practice Address - Street 1:12563 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3427
Practice Address - Country:US
Practice Address - Phone:440-878-9800
Practice Address - Fax:440-878-9804
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000183171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist