Provider Demographics
NPI:1437635919
Name:SCHROCK, ANDREA (EDS SCHOOL PSYCHOLO)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:SCHROCK
Suffix:
Gender:F
Credentials:EDS SCHOOL PSYCHOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-3703
Mailing Address - Country:US
Mailing Address - Phone:815-821-1575
Mailing Address - Fax:
Practice Address - Street 1:200 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:IL
Practice Address - Zip Code:61024-9403
Practice Address - Country:US
Practice Address - Phone:815-821-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL655637103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL655637OtherILLINOIS STATE BOARD OF EDUCATION