MEDICARE: MOLLY SCHROEDER M.S.

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1316297021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY SCHROEDER M.S.

Provider Business Mailing Address
First Line	:	125 CENTRAL AVE STE 290
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2342
Country	:	US
Telephone Number	:	541-267-2113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2790 BROADWAY ST
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2216
Country	:	US
Telephone Number	:	541-751-0871
Fax Number	:

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

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	09/11/2012

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