Healthcare Provider Details

I. General information

NPI: 1730772070
Provider Name (Legal Business Name): DIANE SCHROEDER LLPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 PARCHMENT DR SE STE 100
GRAND RAPIDS MI
49546-2307
US

IV. Provider business mailing address

826 PARCHMENT DR SE STE 100
GRAND RAPIDS MI
49546-2307
US

V. Phone/Fax

Practice location:
  • Phone: 616-540-0026
  • Fax:
Mailing address:
  • Phone: 616-540-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE SCHROEDER
Title or Position: OWNER
Credential: LPC
Phone: 616-540-0026