Provider Demographics
NPI:1811021959
Name:SCHROEDER, KIMI LEIGH (BS)
Entity type:Individual
Prefix:MRS
First Name:KIMI
Middle Name:LEIGH
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 DEW MIST LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-0325
Mailing Address - Country:US
Mailing Address - Phone:702-468-5971
Mailing Address - Fax:
Practice Address - Street 1:6163 MORNING SPLENDOR WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-1853
Practice Address - Country:US
Practice Address - Phone:702-468-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL23843101YA0400X
INTERN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)