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

Last updated

Feb 21, 2008By the provider in NPPES

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 SchafferNPI 1568473569

Title

President

Phone

(651) 699-4751

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack B. Schaffer, PH.D.

  • Clinical Neuropsychologist
  • Saint Paul, MN
  • NPI 1568473569
  Authorized official Same address or phone

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": []
}

• Casie Iwata, MSW, LICW
• Matthew Iwata, LICSW
• Emily Iwuc, LADC
• Esi Jeanne Izim
• Ellen Jabs, D.C.
• Lisa E. Jack, PH.D., LP
• Tremia Jack
• Tamara Jackman
• Jackson Medical Equipment, Inc.
• Jackson Scmitz, PA (Ken Schmitz, LICSW)

• Clinical Neuropsychologist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• 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.