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:
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Health care specialties

SpecialtyCodeLicense #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 19 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568473569 NPPES
Minnesota MEDICAID 4313086

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