Provider Demographics
NPI:1649336785
Name:SCHROEDER, JERI LYNN (LCPC)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:LYNN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LCPC
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 10465
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-0465
Mailing Address - Country:US
Mailing Address - Phone:207-415-3733
Mailing Address - Fax:
Practice Address - Street 1:20 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4380
Practice Address - Country:US
Practice Address - Phone:207-415-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health