Schaffer, Jack B.
Schaffer, Jack B. is an sole proprietor health care provider with primary practice located at 1790 Goodrich Ave , Saint Paul MN 55105-1907. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Health, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Neuropsychologist. Behavioral Health & Social Service Providers / Clinical Neuropsychologist is his primary health care specialty. Schaffer, Jack B. can be contacted via phone (651) 699-4751.Contact Information
Primary practice address
1790 Goodrich Ave
Saint Paul MN 55105-1907
Phone: (651) 699-4751
Fax: (651) 699-0826
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Health | 103TH0004X | LP0311 | Minnesota |
Behavioral Health & Social Service Providers / Clinical | 103TC0700X | LP0311 | Minnesota |
Behavioral Health & Social Service Providers / Clinical Neuropsychologist | 103G00000X | LP0311 | Minnesota |
Profile Details
NPI number | 1568473569 |
---|---|
LBN Legal business name | Schaffer, Jack B. |
Credentials | PH.D. |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Aug 11th, 2006 |
Last updated | Nov 15th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1568473569 | NPPES |
Minnesota | MEDICAID | 4313086 |
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