Provider Demographics
NPI:1144244047
Name:SCHAEFER, DUANE G (LADC)
Entity Type:Individual
Prefix:MR
First Name:DUANE
Middle Name:G
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 LOCH LOMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3912
Mailing Address - Country:US
Mailing Address - Phone:763-458-3863
Mailing Address - Fax:
Practice Address - Street 1:9201 75TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1024
Practice Address - Country:US
Practice Address - Phone:633-157-1707
Practice Address - Fax:763-315-7174
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301293101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)