MEDICARE: DR. KATHRYN R. SHRODER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	4835	OH
2	103TS0200X	School Psychologist	4835	OH

General Provider Information

NPI Number	:	1114087848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN R. SHRODER PH.D.

Provider Business Mailing Address
First Line	:	9325 BAY HILL DR NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-6705
Country	:	US
Telephone Number	:	330-609-9980
Fax Number	:

Provider Business Practice Location Address
First Line	:	9325 BAY HILL DR NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-6705
Country	:	US
Telephone Number	:	330-609-9980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	09/11/2025

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