Provider Demographics
NPI:1265765903
Name:SCHROEDER, CHRISTINE ANN (LLMSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:RACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 JEFFERSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4304
Mailing Address - Country:US
Mailing Address - Phone:616-889-0125
Mailing Address - Fax:
Practice Address - Street 1:40 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4304
Practice Address - Country:US
Practice Address - Phone:616-889-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091596104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker