Provider Demographics
NPI:1306246426
Name:SCHNIEDERS, MYRA J (MSW, LISW, IADC)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:J
Last Name:SCHNIEDERS
Suffix:
Gender:F
Credentials:MSW, LISW, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5123
Mailing Address - Country:US
Mailing Address - Phone:515-573-0933
Mailing Address - Fax:
Practice Address - Street 1:1813 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5123
Practice Address - Country:US
Practice Address - Phone:515-573-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0077821041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker