Healthcare Provider Details

I. General information

NPI: 1093383283
Provider Name (Legal Business Name): MALLORY SCHROEDER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 W NATIONAL AVE
WEST ALLIS WI
53227-2028
US

IV. Provider business mailing address

10243 W NATIONAL AVE
WEST ALLIS WI
53227-2028
US

V. Phone/Fax

Practice location:
  • Phone: 414-604-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02474
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1131156
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA13104
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: