Provider Demographics
NPI:1982968079
Name:SCHROEDER, REBECCA ANN
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:ANN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 W ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3818
Mailing Address - Country:US
Mailing Address - Phone:773-327-6503
Mailing Address - Fax:
Practice Address - Street 1:5801 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6007
Practice Address - Country:US
Practice Address - Phone:312-744-1906
Practice Address - Fax:312-774-5568
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health