MEDICARE: DR. KATHRYN PAMELA WILDER SCHAAF PHD

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	103TR0400X	Rehabilitation Psychologist
2	106H00000X	Marriage & Family Therapist
3	103TC0700X	Clinical Psychologist	0810004502	VA

General Provider Information

NPI Number	:	1659632081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN PAMELA WILDER SCHAAF PHD

Provider Business Mailing Address
First Line	:	5101 MONUMENT AVE STE 103
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3621
Country	:	US
Telephone Number	:	804-596-0794
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 MONUMENT AVE STE 103
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3621
Country	:	US
Telephone Number	:	804-596-0794
Fax Number	:

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

Provider Enumeration Date	:	06/01/2012
Last Update Date	:	04/03/2023

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