Healthcare Provider Details

I. General information

NPI: 1265325922
Provider Name (Legal Business Name): SYDNEY SCHAEFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 MINNETONKA BLVD STE 202
ST LOUIS PARK MN
55416-2211
US

IV. Provider business mailing address

701 6TH AVE S
HOPKINS MN
55343-7718
US

V. Phone/Fax

Practice location:
  • Phone: 612-444-6461
  • Fax:
Mailing address:
  • Phone: 218-230-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: