Provider Demographics
NPI:1154593507
Name:SCHROEDER, ALICIA M (LAC, LADC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LAC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 9TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2018
Mailing Address - Country:US
Mailing Address - Phone:701-282-6561
Mailing Address - Fax:701-277-0306
Practice Address - Street 1:715 11TH ST N STE 204
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2000
Practice Address - Country:US
Practice Address - Phone:218-233-6398
Practice Address - Fax:218-236-6765
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1569101YA0400X
MN302261101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)