Provider Demographics
NPI:1376213330
Name:SCHROEDER, DANI RAE (EDS)
Entity type:Individual
Prefix:
First Name:DANI
Middle Name:RAE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 NW KLINE ST APT 5
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1761
Mailing Address - Country:US
Mailing Address - Phone:808-895-8324
Mailing Address - Fax:
Practice Address - Street 1:2560 NW KLINE ST APT 5
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1761
Practice Address - Country:US
Practice Address - Phone:808-895-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC306361103TS0200X
OR103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool