=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154680023
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN SCHROEDER PSYD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2012
-----------------------------------------------------
Last Update Date | 05/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7829 E ROCKHILL ST STE. 105
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-3920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-293-3850
-----------------------------------------------------
Fax | 316-683-6733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 N KANSAS ST SUITE3054
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67214-3124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-293-3429
-----------------------------------------------------
Fax | 316-293-1882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | 2027
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------