Provider Demographics
NPI:1700148640
Name:SCHROEDER, AMANDA KATE (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KATE
Other - Last Name:SCHMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:510 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4404
Mailing Address - Country:US
Mailing Address - Phone:920-783-6633
Mailing Address - Fax:
Practice Address - Street 1:510 S 8TH STREET
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4006
Practice Address - Country:US
Practice Address - Phone:920-783-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4799-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional