Provider Demographics
NPI:1801324058
Name:SCHROEDER, MORGAN GABRIELLE (PHD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:GABRIELLE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:GABRIELLE
Other - Last Name:MCCARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:12176 S 1000 E STE 12
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-3221
Mailing Address - Country:US
Mailing Address - Phone:801-613-9184
Mailing Address - Fax:
Practice Address - Street 1:12176 S 1000 E STE 12
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-3221
Practice Address - Country:US
Practice Address - Phone:801-613-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
UT12497106-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician