Provider Demographics
NPI:1699878256
Name:SCHUMACHER, KEVIN MAKAY (PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MAKAY
Last Name:SCHUMACHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 32ND AVE S
Mailing Address - Street 2:SUITE 223
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6159
Mailing Address - Country:US
Mailing Address - Phone:701-365-4488
Mailing Address - Fax:701-365-0727
Practice Address - Street 1:3120 25TH ST S STE Z
Practice Address - Street 2:#340
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6164
Practice Address - Country:US
Practice Address - Phone:701-365-4488
Practice Address - Fax:701-365-0727
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND111103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16951Medicaid
MN909550100OtherMEDICAID
ND16951Medicaid