Healthcare Provider Details

I. General information

NPI: 1609896653
Provider Name (Legal Business Name): JAMES F SCHROEDER PHD/HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 BELLEMEADE AVE
EVANSVILLE IN
47714-0136
US

IV. Provider business mailing address

3701 BELLEMEADE AVE
EVANSVILLE IN
47714-0136
US

V. Phone/Fax

Practice location:
  • Phone: 812-479-1411
  • Fax: 812-437-2636
Mailing address:
  • Phone: 812-479-1411
  • Fax: 812-437-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042287A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042287A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20042287A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: