Provider Demographics
NPI:1194158006
Name:SCHALEKAMP, JENNIFER L (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SCHALEKAMP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:430 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1426
Mailing Address - Country:US
Mailing Address - Phone:218-641-7725
Mailing Address - Fax:218-641-6625
Practice Address - Street 1:430 5TH ST N
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520
Practice Address - Country:US
Practice Address - Phone:218-641-7725
Practice Address - Fax:218-641-6625
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9317225100000X
NE3523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist