Provider Demographics
NPI:1386984433
Name:SCHROEDER, JEFFREY ALPHONSE (CSAC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALPHONSE
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MILWAUKEE AVE W
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538
Mailing Address - Country:US
Mailing Address - Phone:920-568-5046
Mailing Address - Fax:920-568-4004
Practice Address - Street 1:210 MILWAUKEE AVE W
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-2022
Practice Address - Country:US
Practice Address - Phone:920-568-5046
Practice Address - Fax:920-568-4004
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI385-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI385-132OtherWI STATE LICENSE NUMBER