Provider Demographics
NPI:1467164384
Name:SCHROEDER, JIMENA DEL CARPIO (MED, PHD)
Entity type:Individual
Prefix:
First Name:JIMENA
Middle Name:DEL CARPIO
Last Name:SCHROEDER
Suffix:
Gender:
Credentials:MED, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 PAGE DR S STE 101
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3551
Mailing Address - Country:US
Mailing Address - Phone:701-300-8879
Mailing Address - Fax:
Practice Address - Street 1:1330 PAGE DR S STE 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3551
Practice Address - Country:US
Practice Address - Phone:701-300-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1031-10-1-19101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty