MEDICARE: JENNIFER L SCHROEDER PHD, LSSP

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	103T00000X	Psychologist	32525	TX
2	103TS0200X	School Psychologist	32339	TX

General Provider Information

NPI Number	:	1174747679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L SCHROEDER PHD, LSSP

Provider Business Mailing Address
First Line	:	PO BOX 871803
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75187-1803
Country	:	US
Telephone Number	:	214-498-4707
Fax Number	:

Provider Business Practice Location Address
First Line	:	6138 RINCON WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2035
Country	:	US
Telephone Number	:	214-498-4707
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	06/18/2009

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