Provider Demographics
NPI:1235608894
Name:SCHWAB, ANDREW MARK
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK
Last Name:SCHWAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9517 CHAD DR NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-9032
Mailing Address - Country:US
Mailing Address - Phone:218-410-0155
Mailing Address - Fax:
Practice Address - Street 1:9517 CHAD DR NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-9032
Practice Address - Country:US
Practice Address - Phone:218-410-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness