Provider Demographics
NPI:1457037459
Name:SCHROEDER, SHANICE MARIE
Entity Type:Individual
Prefix:
First Name:SHANICE
Middle Name:MARIE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-2422
Mailing Address - Country:US
Mailing Address - Phone:712-541-0095
Mailing Address - Fax:
Practice Address - Street 1:515 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-2422
Practice Address - Country:US
Practice Address - Phone:712-541-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst