Individual
AMANDA SCHROEDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
807 SW F AVE, LAWTON, OK 73501-4506
(580) 595-7000
(580) 595-7005
Mailing address
804 W. CHOCTAW, CHICKASAH, OK 73108
(405) 222-0622
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
#5111-P
OK
1041C0700X
Clinical Social Worker
#5111-P
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
731545165
—
OK
Enumeration date
06/08/2015
Last updated
07/31/2015
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