Jack B Schaffer PHD PA

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

LP0311 Issued in MN

Legal business name

JACK B SCHAFFER PHD PA

Practice address

1790 Goodrich Ave
Saint Paul, MN 55105-1907

Phone

(651) 699-4751

NPI assigned

Feb 21, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jack B Schaffer

Title

President

Phone

(651) 699-4751

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1203552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203552000000",
    "number": "1891964086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 GOODRICH AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051907",
            "telephone_number": "651-699-4751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 GOODRICH AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051907",
            "telephone_number": "651-699-4751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK B SCHAFFER PHD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-21",
        "last_updated": "2008-02-21",
        "status": "A",
        "authorized_official_last_name": "SCHAFFER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-699-4751",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "MN",
            "license": "LP0311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Anne Iverson, M.D.
• Casie Iwata, MSW, LICW
• Matthew Iwata, LICSW
• Emily Iwuc, LADC
• Ellen Jabs, D.C.
• Lisa E. Jack, PH.D., LP
• Tremia Jack
• Tamara Jackman
• Jackson Medical Equipment, Inc.
• Jackson Scmitz, PA

• All providers in Saint Paul, MN
• Clinical Neuropsychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.