Provider Demographics
NPI:1083782486
Name:SCHAEFER, RUTH ANN (MSLP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6352 HIGHLAND SCENIC RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8353
Mailing Address - Country:US
Mailing Address - Phone:218-828-1340
Mailing Address - Fax:218-828-1340
Practice Address - Street 1:115 1ST STREET N
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401
Practice Address - Country:US
Practice Address - Phone:218-828-6274
Practice Address - Fax:218-828-4209
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0510103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04RAS6558OtherGAMBLING TREATMENT
MN180POSCOtherBLUECROSS BLUESHIELD
MNHP32669OtherHEALTH PARTNERS
MN62-59554OtherUNITED BEHAVIORAL HEALTH
MN150062OtherU CARE