Basic Information
| Provider Information | |||||||||
| NPI: | 1245589951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHROEDER | ||||||||
| FirstName: | SEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 MELROSE ST APT B6 | ||||||||
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| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993621479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532414062 | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 KIRMAN AVE | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895020993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757867200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2012 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.