Provider Demographics
NPI:1437798949
Name:SCHAEFER, MANDY SUE
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:SUE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 MILL ST
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-2115
Mailing Address - Country:US
Mailing Address - Phone:775-293-5639
Mailing Address - Fax:
Practice Address - Street 1:1346 MILL ST
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-2115
Practice Address - Country:US
Practice Address - Phone:775-293-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician