Provider Demographics
NPI:1295897247
Name:SCHAFER, RONALD W (PHD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 E 3RD ST
Mailing Address - Street 2:201
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3478
Mailing Address - Country:US
Mailing Address - Phone:507-452-7292
Mailing Address - Fax:507-457-9887
Practice Address - Street 1:1707 MAIN ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4200
Practice Address - Country:US
Practice Address - Phone:608-785-0001
Practice Address - Fax:608-785-0002
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1291-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39043800Medicaid
MN3H051SCOtherBCBS-MN
MN127371Medicaid
MNHP65356OtherHEALTHPARTNERS
WI39043800Medicaid