Provider Demographics
NPI:1770546715
Name:SCHRECK, RODNEY (LISW)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:
Last Name:SCHRECK
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W MAIN ST
Mailing Address - Street 2:PO BOX 359
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1526
Mailing Address - Country:US
Mailing Address - Phone:563-927-7746
Mailing Address - Fax:563-927-7444
Practice Address - Street 1:709 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1526
Practice Address - Country:US
Practice Address - Phone:563-927-7746
Practice Address - Fax:563-927-7444
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA018161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0091637Medicaid
IA231738OtherMIDLANDS
IAI1807OtherPTAN
IA09971OtherBCIA
IAIA0131OtherJOHN DEERE
IAI1807OtherPTAN