MEDICARE: MRS. MONIQUE F SCHRADER MALPC

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	101Y00000X	Counselor	2005038682	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538204904	OTHER	MO	BOONVILLE LOCATION NPI
2	1649269622	OTHER	MO	BILLING NPI

General Provider Information

NPI Number	:	1891758736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONIQUE F SCHRADER MALPC

Provider Business Mailing Address
First Line	:	16942 HOLIDAY CIR
Second Line	:
City	:	BOONVILLE
State	:	MO
Zip	:	65233-3529
Country	:	US
Telephone Number	:	660-882-2333
Fax Number	:	660-882-2333

Provider Business Practice Location Address
First Line	:	15899 LOGANS LAKE RD
Second Line	:
City	:	BOONVILLE
State	:	MO
Zip	:	65233-2866
Country	:	US
Telephone Number	:	660-882-2333
Fax Number	:	660-882-2333

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/13/2007

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