Provider Demographics
NPI:1134170525
Name:SCHIPPER, ROGER LEE (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:LEE
Last Name:SCHIPPER
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 THELEN FARM TRL
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:WI
Mailing Address - Zip Code:54082-2062
Mailing Address - Country:US
Mailing Address - Phone:715-549-0030
Mailing Address - Fax:715-549-0060
Practice Address - Street 1:516 15TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0120
Practice Address - Country:US
Practice Address - Phone:612-626-8771
Practice Address - Fax:612-626-7748
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN780612OtherNATA MEMBERSHIP