Provider Demographics
NPI:1689057705
Name:SCHAEFFER, BRENDA (MALP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:MALP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 PARK COMMONS DR
Mailing Address - Street 2:401
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5173
Mailing Address - Country:US
Mailing Address - Phone:952-944-4046
Mailing Address - Fax:
Practice Address - Street 1:4525 PARK COMMONS DR
Practice Address - Street 2:401
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-5173
Practice Address - Country:US
Practice Address - Phone:952-944-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0846103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MILP 0486OtherMINNESOTA LICENSED PSYCHOLOGIST