Provider Demographics
NPI:1285796623
Name:SCHROEDER, MARY MARGARET
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:HOSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 E ADELAIDE
Mailing Address - Street 2:#6
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719
Mailing Address - Country:US
Mailing Address - Phone:520-722-1844
Mailing Address - Fax:
Practice Address - Street 1:1401 E ADELAIDE
Practice Address - Street 2:#6
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-722-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional