Provider Demographics
NPI:1518273200
Name:SCHIECK, JACQUELYN RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:RAE
Last Name:SCHIECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:RAE
Other - Last Name:KOLBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1531 CLINTON LN
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3295
Mailing Address - Country:US
Mailing Address - Phone:507-581-8575
Mailing Address - Fax:507-216-6042
Practice Address - Street 1:1531 CLINTON LN
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3295
Practice Address - Country:US
Practice Address - Phone:507-581-8575
Practice Address - Fax:507-216-6042
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDTEMP2871223X0400X
MND131771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics