Provider Demographics
NPI:1700184009
Name:SCHROEDER, MARY C (PMHCNS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PMHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 HOLLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1706
Mailing Address - Country:US
Mailing Address - Phone:317-218-3602
Mailing Address - Fax:
Practice Address - Street 1:4040 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-7800
Practice Address - Country:US
Practice Address - Phone:317-876-3699
Practice Address - Fax:317-876-3600
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28070089A364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult