Healthcare Provider Details

I. General information

NPI: 1134965411
Provider Name (Legal Business Name): CORRINA SCHADER MA PPS LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORRINA LICON

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 E PERRIN AVE APT 271
FRESNO CA
93720-4283
US

IV. Provider business mailing address

1160 E PERRIN AVE APT 271
FRESNO CA
93720-4283
US

V. Phone/Fax

Practice location:
  • Phone: 559-696-3231
  • Fax:
Mailing address:
  • Phone: 559-696-3231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4240
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number230128238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: