Healthcare Provider Details

I. General information

NPI: 1730240359
Provider Name (Legal Business Name): JULIE ANNA SCHAEFER SPACE MS, MLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 THORNTON ST
MIDDLEVILLE MI
49333-9706
US

IV. Provider business mailing address

P.O. BOX 339 402 THORNTON STREET
MIDDLEVILLE MI
49333-4209
US

V. Phone/Fax

Practice location:
  • Phone: 269-795-2243
  • Fax: 269-795-5315
Mailing address:
  • Phone: 269-795-2243
  • Fax: 269-795-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301007868
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: