Individual
DR. JACK B. SCHAFFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1790 GOODRICH AVE, SAINT PAUL, MN 55105-1907
(651) 699-4751
(651) 699-0826
Mailing address
1790 GOODRICH AVE, SAINT PAUL, MN 55105-1907
(651) 699-4751
(651) 699-0826
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
LP0311
MN
103TC0700X
Clinical Psychologist
LP0311
MN
103TH0004X
Health Psychologist
LP0311
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4313086
—
MN
Enumeration date
08/11/2006
Last updated
11/15/2007
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