Provider Demographics
NPI:1063560449
Name:SCHROOTEN, VIRGINIA S (BS)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:S
Last Name:SCHROOTEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:S
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:231 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1045
Mailing Address - Country:US
Mailing Address - Phone:502-437-5066
Mailing Address - Fax:
Practice Address - Street 1:231 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1045
Practice Address - Country:US
Practice Address - Phone:502-437-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0452Medicare ID - Type UnspecifiedMEDICARE