MEDICARE: MR. DUANE G SCHAEFER LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	301293	MN

General Provider Information

NPI Number	:	1144244047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUANE G SCHAEFER LADC

Provider Business Mailing Address
First Line	:	8730 LOCH LOMOND BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3912
Country	:	US
Telephone Number	:	763-458-3863
Fax Number	:

Provider Business Practice Location Address
First Line	:	9201 75TH AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-1024
Country	:	US
Telephone Number	:	633-157-1707
Fax Number	:	763-315-7174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/06/2020

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