Provider Demographics
NPI:1528884228
Name:SHRADER, RODNEY PAUL
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:PAUL
Last Name:SHRADER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2377
Mailing Address - Country:US
Mailing Address - Phone:931-723-0380
Mailing Address - Fax:
Practice Address - Street 1:806 CLOVER LN
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2377
Practice Address - Country:US
Practice Address - Phone:931-723-0380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling