Provider Demographics
NPI:1972230902
Name:SCHROEDER, MEGHAN NICOLE
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:NICOLE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 W 76TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5118
Mailing Address - Country:US
Mailing Address - Phone:952-923-9423
Mailing Address - Fax:
Practice Address - Street 1:6300 W OLD SHAKOPEE RD STE 102
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-2684
Practice Address - Country:US
Practice Address - Phone:612-261-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician