Provider Demographics
NPI:1699941906
Name:AAC PSYCHIATRIC SERVICES PA
Entity type:Organization
Organization Name:AAC PSYCHIATRIC SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILYPSYCHIATRICNURSEPRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FPMHNP
Authorized Official - Phone:218-368-6391
Mailing Address - Street 1:1526 30TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4140
Mailing Address - Country:US
Mailing Address - Phone:218-751-0887
Mailing Address - Fax:
Practice Address - Street 1:1526 30TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4140
Practice Address - Country:US
Practice Address - Phone:218-751-0887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 159021-8261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health