Doctor Name: | MR. DAVID EDWARD SCHLACK |
NPI Number: | 1144495391 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC |
License Number: | 300543 |
Business Practice Address: | 1326 East Ripley Street Litchfield, MN - 55355 |
Business Phone Number: | 3205930440 |
Business Fax Number: | 3205430442 |
Mailing Address: | 1326 East Ripley Street, LITCHFIELD |
State: | MN |
Postal Code: | 55355 |
Phone Number: | 3205930440 |
Fax Number: | 3205430442 |
NPI Enumeration Date: | 04/29/2008 |
NPI Last Update Date: | 04/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TA0400X |
License Number: | 300543 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |