DR. JACK B. SCHAFFER (NPI# 1568473569) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568473569 |
| Entity Type | Individual |
| Full Name | DR. JACK B. SCHAFFER |
| Credential | PH.D. |
| Practice Address |
1790 Goodrich Ave Saint Paul MN 55105-1907 |
| Practice Telephone | 6516994751 |
| Practice Fax Number | 6516990826 |
| Mailing Telephone | 6516994751 |
| Mailing Fax Number | 6516990826 |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-11-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | LP0311 | MN | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
LP0311 | MN | Behavioral Health & Social Service Providers |
| N | 103TH0004X |
Psychologist Specialization: Health |
LP0311 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 4313086 | 05 |
| Street Address |
1790 GOODRICH AVE |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55105-1907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891964086 | Jack B Schaffer Phd Pa | Clinical Neuropsychologist | 1790 Goodrich Ave, Saint Paul, MN 55105-1907 | 2008-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437704020 | Grand Avenue Smiles | Dentist | 1845 Grand Avenue, St. Paul, MN 55105 | 2019-08-09 |
| 1205304839 | Michelle Marie Loken Price | Acupuncturist | 877 Lincoln Ave, Saint Paul, MN 55105 | 2018-11-13 |
| 1326566936 | Becky Lynn Lawyer | Counselor | 1704 Palace Ave, St Paul, MN 55105 | 2017-09-04 |
| 1679020226 | Internal Revolution Counseling and Consulting, L.L.C. | Psychologist | 1123 Grand Avenue, Suite 201, Saint Paul, MN 55105 | 2016-09-01 |
| 1487059689 | Jennifer Mason | Lactation Consultant, Non-RN | 1382 Summit Ave, Saint Paul, MN 55105 | 2014-10-30 |
| 1679818850 | Marc Lane Wolfson | Registered Nurse | 1148 Grand Avenue, St. Paul, MN 55105 | 2012-11-29 |
| 1457602781 | Charting Your Success | Social Worker | 2050 St Clair Avenue, Suite 1e, St Paul, MN 55105 | 2012-09-26 |
| 1871867549 | Stacia Hanson Ma Lp LLC | Psychologist | 889 Grand Avenue, Suite 203, St Paul, MN 55105 | 2012-02-28 |
| 1265718142 | Caitlin Marie Young | Midwife | 968 Grand Ave., St. Paul, MN 55105 | 2011-10-24 |
| 1659512622 | Wellness Cooperative LLC | Chiropractor | 976 Grand Ave., St. Paul, MN 55105 | 2009-03-20 |
| Find all providers in zip 55105 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013557057 | Erik De Water | Clinical Neuropsychologist | 1876 Minnehaha Ave W, Saint Paul, MN 55104-1029 | 2020-01-07 |
| 1609333038 | Minnesota Neuropsychology, LLC | Clinical Neuropsychologist | 370 Selby Ave Ste 312, Saint Paul, MN 55102-1884 | 2019-02-21 |
| 1629150479 | Nan C Truitt | Clinical Neuropsychologist | 265 Phalen Blvd, Saint Paul, MN 55130-2400 | 2006-10-20 |
| 1619066446 | Kristen Ann Ryan | Clinical Neuropsychologist | 190 5th St E, Ste. 100, Saint Paul, MN 55101-2666 | 2006-10-12 |
| 1770689705 | Gale Valtinson & Associates Pa | Clinical Neuropsychologist | 423 Warwick St, Saint Paul, MN 55105-2548 | 2006-09-16 |
| 1053936922 | Suzanne Moseley | Clinical Neuropsychologist | 225 Smith Ave N, Saint Paul, MN 55102-2533 | 2020-06-16 |
| 1720540974 | Tou Khang | Clinical Neuropsychologist | 393 Dunlap St N Ste 105, Saint Paul, MN 55104-4211 | 2019-04-04 |
| 1811434038 | Sarah Marie Olson | Clinical Neuropsychologist | 1700 University Ave W Fl 6, Saint Paul, MN 55104-3727 | 2017-01-25 |
| 1437576840 | Jordan Robinson | Clinical Neuropsychologist | 1700 University Ave W Fl 6, Saint Paul, MN 55104-3727 | 2014-03-24 |
| 1750652350 | Kara L Leiser | Clinical Neuropsychologist | 200 University Ave E, Saint Paul, MN 55101-2507 | 2012-01-13 |
| Find all providers in SAINT PAUL | ||||
| City | SAINT PAUL |
| Zip Code | 55105 |
Please comment or provide details below to improve the information on DR. JACK B. SCHAFFER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.