Healthcare Provider Details

I. General information

NPI: 1437809217
Provider Name (Legal Business Name): GRACE SCHROEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17982 SKY PARK CIR STE J
IRVINE CA
92614-6482
US

IV. Provider business mailing address

425 S PARKER ST
ORANGE CA
92868-4024
US

V. Phone/Fax

Practice location:
  • Phone: 310-819-4523
  • Fax: 877-394-6799
Mailing address:
  • Phone: 714-606-0174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: