Provider Demographics
NPI:1285732438
Name:SCHROEDER, KATHLEEN ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6254
Mailing Address - Country:US
Mailing Address - Phone:815-455-3110
Mailing Address - Fax:815-455-7302
Practice Address - Street 1:278 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6254
Practice Address - Country:US
Practice Address - Phone:815-455-3110
Practice Address - Fax:815-455-7302
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry