MEDICARE: DR. DAVID WALTER SCHROEDER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	116998-2501	UT
2	103TC0700X	Clinical Psychologist	24128	CA
3	103TC2200X	Clinical Child & Adolescent Psychologist	11698-2501	UT
4	103TC2200X	Clinical Child & Adolescent Psychologist	24128	CA

General Provider Information

NPI Number	:	1134341886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WALTER SCHROEDER PH.D.

Provider Business Mailing Address
First Line	:	2451 S BUFFALO DR STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2749
Country	:	US
Telephone Number	:	801-502-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 S BUFFALO DR STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2749
Country	:	US
Telephone Number	:	702-829-8065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	10/13/2020

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