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General NPI Number Information
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NPI Number | 1558495481
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Entity Type | Individual
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Provider Name | ILENE SCHROEDER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 675 SEMINOLE AVE NE STE 107
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City | ATLANTA
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State | GA
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Zip | 30307-3411
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Country | US
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Telephone | 404-873-6840
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Fax | 404-881-8410
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Provider Business Mailing Address
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Address Line | 675 SEMINOLE AVE NE STE 107
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City | ATLANTA
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State | GA
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Zip | 30307-3411
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Country | US
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Telephone | 404-873-6840
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Fax | 404-881-8410
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY001104
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License Number State | GA
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