Provider Demographics
NPI:1972070860
Name:SCHOETTLE, MARY C
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:SCHOETTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:306 W SUPERIOR ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1818
Mailing Address - Country:US
Mailing Address - Phone:184-817-6602
Mailing Address - Fax:218-216-1452
Practice Address - Street 1:306 W SUPERIOR ST STE 1000
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1818
Practice Address - Country:US
Practice Address - Phone:218-481-7660
Practice Address - Fax:218-216-1452
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN281461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1972070860Medicaid