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NPI Code Detail

MEDICARE: DR. DAVID JASON SCHROERLUCKE PSY.D.

MEDICARE: DR. DAVID JASON SCHROERLUCKE PSY.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
1103TC0700XClinical Psychologist267542KY

General Provider Information

NPI Number : 1598071474
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID JASON SCHROERLUCKE PSY.D.
Provider Business Mailing Address
First Line : 633 BAXTER AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1157
Country : US
Telephone Number : 502-309-2408
Fax Number :
Provider Business Practice Location Address
First Line : 633 BAXTER AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1157
Country : US
Telephone Number : 502-309-2408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2010
Last Update Date : 11/22/2020

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