Provider Demographics
NPI:1942513056
Name:SCHROEDER, JESSICA LYNN (MS, LCMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:MS, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 VINE ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-3430
Mailing Address - Country:US
Mailing Address - Phone:913-579-3557
Mailing Address - Fax:913-273-6818
Practice Address - Street 1:205 S 5TH ST
Practice Address - Street 2:STE 22
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-2602
Practice Address - Country:US
Practice Address - Phone:913-579-3557
Practice Address - Fax:913-273-6818
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT 821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200676720AMedicaid