Provider Demographics
NPI:1629116199
Name:SCHROEDER, JACKE LYNN (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:JACKE
Middle Name:LYNN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:RABBI JACKE
Other - Middle Name:L
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW-C
Mailing Address - Street 1:30 OVER RIDGE CT APT 2122
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1126
Mailing Address - Country:US
Mailing Address - Phone:410-365-4157
Mailing Address - Fax:
Practice Address - Street 1:30 OVER RIDGE CT APT 2122
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1126
Practice Address - Country:US
Practice Address - Phone:410-365-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical