Provider Demographics
NPI:1316615206
Name:SCHUMACK, ELIZABETH MARY (LICSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:SCHUMACK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2351
Mailing Address - Country:US
Mailing Address - Phone:612-232-6857
Mailing Address - Fax:
Practice Address - Street 1:4284 DAHLBERG DR
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4805
Practice Address - Country:US
Practice Address - Phone:612-888-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN275941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty