Provider Demographics
NPI:1265977888
Name:SCHROEDER, IAN Z (LPC, CADC III)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:Z
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:LPC, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:WELCHES
Mailing Address - State:OR
Mailing Address - Zip Code:97067-0469
Mailing Address - Country:US
Mailing Address - Phone:971-236-4611
Mailing Address - Fax:971-293-2311
Practice Address - Street 1:2236 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2817
Practice Address - Country:US
Practice Address - Phone:503-445-7699
Practice Address - Fax:503-802-0199
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-R-04101YA0400X
101YM0800X, 101Y00000X
ORC6086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional