Provider Demographics
NPI:1225007701
Name:SCHATTENBERG, ANN BRENDAN (PSYD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:BRENDAN
Last Name:SCHATTENBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 WILLOW ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2269
Mailing Address - Country:US
Mailing Address - Phone:612-345-4756
Mailing Address - Fax:612-345-4757
Practice Address - Street 1:1409 WILLOW ST
Practice Address - Street 2:SUITE 610
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2269
Practice Address - Country:US
Practice Address - Phone:612-345-4756
Practice Address - Fax:612-345-4757
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4579103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist