Provider Demographics
NPI:1043057128
Name:SCHROEDER, MARY GRACE (AUD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:GRACE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 GOODALL CT
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-0803
Mailing Address - Country:US
Mailing Address - Phone:618-240-4654
Mailing Address - Fax:
Practice Address - Street 1:2825 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-1701
Practice Address - Country:US
Practice Address - Phone:765-523-4273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002853A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist