Provider Demographics
NPI:1649141334
Name:SCHROEDER, DANIELLE ASHLEY
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ASHLEY
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2741
Mailing Address - Country:US
Mailing Address - Phone:228-284-2644
Mailing Address - Fax:855-402-2013
Practice Address - Street 1:1601 30TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2741
Practice Address - Country:US
Practice Address - Phone:228-284-2644
Practice Address - Fax:855-402-2013
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional