Provider Demographics
NPI:1215267927
Name:SCHROEDER, KATHERINE K (PA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:K
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:STOESZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5821 CEDAR LAKE RD S STE 203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1487
Mailing Address - Country:US
Mailing Address - Phone:612-293-0352
Mailing Address - Fax:612-464-7879
Practice Address - Street 1:5821 CEDAR LAKE RD S STE 203
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1487
Practice Address - Country:US
Practice Address - Phone:612-293-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112822084P0015X, 364SF0001X, 364SH1100X, 364SP0809X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolistic
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN11282OtherSTATE LICENSE
CAPA20708OtherLICENSE