Provider Demographics
NPI:1407216591
Name:SCHROEDER, KENNETH JOHN I (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOHN
Last Name:SCHROEDER
Suffix:I
Gender:M
Credentials:MA, LPC
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Mailing Address - Street 1:1520 N MCCARTHY RD APT 8
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8296
Mailing Address - Country:US
Mailing Address - Phone:920-531-2653
Mailing Address - Fax:920-982-5040
Practice Address - Street 1:E7475 RAWHIDE RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-9025
Practice Address - Country:US
Practice Address - Phone:920-538-4504
Practice Address - Fax:920-982-5040
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2679-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional