Healthcare Provider Details

I. General information

NPI: 1316430861
Provider Name (Legal Business Name): LACEY SCHROEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2018
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 HENTHORNE DR STE C
MAUMEE OH
43537-1370
US

IV. Provider business mailing address

1627 HENTHORNE DR STE C
MAUMEE OH
43537-1370
US

V. Phone/Fax

Practice location:
  • Phone: 419-491-0420
  • Fax: 567-698-7875
Mailing address:
  • Phone: 567-395-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1701158
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: