David Edward Schlack, LADC

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

License

300543 Issued in MN

Practice address

1326 East Ripley Street
Litchfield, MN 55355

Phone

(320) 593-0440

Fax

(320) 543-0442

NPI assigned

Apr 29, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• David Edward Schlack Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jacy II LLC

  • Children's Substance Abuse Rehabilitation Facility
  • Litchfield, MN
  • NPI 1760929574
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1144495391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1326 EAST RIPLEY STREET",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "55355",
            "telephone_number": "320-593-0440",
            "fax_number": "320-543-0442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1326 EAST RIPLEY STREET",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "55355",
            "telephone_number": "320-593-0440",
            "fax_number": "320-543-0442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHLACK",
        "first_name": "DAVID",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "300543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAVID",
            "last_name": "SCHLACK",
            "middle_name": "EDWARD",
            "credential": "LUTH PASTOR M OF DIV",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Shannon Reiner, LICSW
• Barry R Rick, CRNA
• Jordan Rodgers, LICSW
• Carol E Sangren, LPN
• Tyler Santjer
• Jane Carol Schmidt, RN CNP
• Scott H Schultz, MD
• Stephanie Schuster, PT
• Richard Merritt Searl, M.D.
• Sibley Dental Suite, PLLC

• All providers in Litchfield, MN
• Addiction (Substance Use Disorder) Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.