Provider Demographics
NPI:1285788653
Name:SCHRODER, TERESA L (AUD, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:SCHRODER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:KENNALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD,CCC-A
Mailing Address - Street 1:18059 HIGHWAY 105 W STE 115
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5001
Mailing Address - Country:US
Mailing Address - Phone:936-582-7000
Mailing Address - Fax:936-582-7001
Practice Address - Street 1:18059 HIGHWAY 105 W STE 115
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5001
Practice Address - Country:US
Practice Address - Phone:936-582-7000
Practice Address - Fax:936-582-7001
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00005231H00000X
TX80734231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS40137017OtherBCBS
KS115887Medicare ID - Type Unspecified
KS40137017OtherBCBS
MOMA1075006Medicare PIN
KS100228160DMedicaid
KSKA1268005Medicare PIN
KSM20000003Medicare PIN
MOMA1443007Medicare PIN