Provider Demographics
NPI:1215039268
Name:NAUSCHULTZ, VICKI L (MEQ LP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:NAUSCHULTZ
Suffix:
Gender:F
Credentials:MEQ LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 CENTRE POINTE DRIVE
Mailing Address - Street 2:35-121A
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 NORTH SMITH AVENUE
Practice Address - Street 2:401
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6750
Practice Address - Fax:651-220-6770
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP2712103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical