Provider Demographics
NPI:1841820131
Name:SCHROEDER, CRISTY LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:LYNN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N 16TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-2782
Mailing Address - Country:US
Mailing Address - Phone:208-642-6160
Mailing Address - Fax:
Practice Address - Street 1:501 N 16TH ST STE 111
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2782
Practice Address - Country:US
Practice Address - Phone:208-642-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-25
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID36802101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health