Provider Demographics
NPI:1962919324
Name:SCHROEDER, NICOLE MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 NW TOWER DR
Mailing Address - Street 2:
Mailing Address - City:PLATTE WOODS
Mailing Address - State:MO
Mailing Address - Zip Code:64151-4463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5420 W 151RST ST.
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224
Practice Address - Country:US
Practice Address - Phone:913-219-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MO2019014046103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBACB348220OtherTRICARE