Healthcare Provider Details

I. General information

NPI: 1114087848
Provider Name (Legal Business Name): KATHRYN R. SHRODER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 BAY HILL DR NE
WARREN OH
44484-6705
US

IV. Provider business mailing address

9325 BAY HILL DR NE
WARREN OH
44484-6705
US

V. Phone/Fax

Practice location:
  • Phone: 330-609-9980
  • Fax:
Mailing address:
  • Phone: 330-609-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4835
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4835
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: