=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295835437
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN DEAN SCHROEDER PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 589 MAIN ST SUITE A
-----------------------------------------------------
City | PLACERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95667-5604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-621-4890
-----------------------------------------------------
Fax | 530-621-2425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 589 MAIN ST SUITE A
-----------------------------------------------------
City | PLACERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95667-5604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-621-4890
-----------------------------------------------------
Fax | 530-621-2425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY11026
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------