Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 116998-2501 | UT |
N | 103TC0700X | Clinical Psychologist | 116998-2501 | UT |
N | 103G00000X | Clinical Psychologist | 24128 | CA |
N | 103TC0700X | Clinical Psychologist | 24128 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 11698-2501 | UT |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 24128 | CA |
NPI | 1134341886 |
---|---|
Provider Name | Dr. David Walter Schroeder |
First Address | Las Vegas, NV 89117-2749 |
Second Address | Las Vegas, NV 89117-2749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 13/10/2020 |