Provider Demographics
NPI:1770143331
Name:SHREFFLER, JAMES VINCENT (PSY D, L P)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VINCENT
Last Name:SHREFFLER
Suffix:
Gender:M
Credentials:PSY D, L P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 HOWARD GNESEN RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-9481
Mailing Address - Country:US
Mailing Address - Phone:218-206-1393
Mailing Address - Fax:
Practice Address - Street 1:324 W SUPERIOR ST STE 620
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1723
Practice Address - Country:US
Practice Address - Phone:218-722-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6416103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist