Provider Demographics
NPI:1508932278
Name:SCHUMACHER, BROCKMAN JR (LP)
Entity Type:Individual
Prefix:
First Name:BROCKMAN
Middle Name:
Last Name:SCHUMACHER
Suffix:JR
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1255
Mailing Address - Country:US
Mailing Address - Phone:612-825-7048
Mailing Address - Fax:612-825-0385
Practice Address - Street 1:5128 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-1255
Practice Address - Country:US
Practice Address - Phone:612-825-7048
Practice Address - Fax:612-825-0385
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0641103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist