=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811190507
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT E SCHNEIDER PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 I STREET, SUITE 440
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-523-0999
-----------------------------------------------------
Fax | 209-529-9671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4506 S.E. FRANKLIN STREET
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-753-8497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY00001493
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY 5580
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------