Healthcare Provider Details

I. General information

NPI: 1447382254
Provider Name (Legal Business Name): ROBERT FRANK SCHROEDER MSCCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 ADDISON AVE E
TWIN FALLS ID
83301-6749
US

IV. Provider business mailing address

2508 ADDISON AVE E
TWIN FALLS ID
83301-6749
US

V. Phone/Fax

Practice location:
  • Phone: 208-733-0601
  • Fax: 208-733-0604
Mailing address:
  • Phone: 208-733-0601
  • Fax: 208-733-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberHAS169
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: