Provider Demographics
NPI:1194548487
Name:SCHAEFER, MASON
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 HARNEY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2638
Mailing Address - Country:US
Mailing Address - Phone:402-204-8049
Mailing Address - Fax:
Practice Address - Street 1:10820 HARNEY ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2638
Practice Address - Country:US
Practice Address - Phone:402-204-8049
Practice Address - Fax:402-819-0954
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician