Provider Demographics
NPI:1538844477
Name:SCHRADER, NICOLE LEA (LMSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEA
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 69TH ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1507
Mailing Address - Country:US
Mailing Address - Phone:515-778-1405
Mailing Address - Fax:
Practice Address - Street 1:3839 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1307
Practice Address - Country:US
Practice Address - Phone:515-669-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1165621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical