Healthcare Provider Details

I. General information

NPI: 1699713479
Provider Name (Legal Business Name): MARK SCHULER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 EXCELSIOR BLVD SUITE 301B
ST LOUIS PARK MN
55416-4960
US

IV. Provider business mailing address

3812 THOMAS AVE S
MINNEAPOLIS MN
55410-1232
US

V. Phone/Fax

Practice location:
  • Phone: 612-435-0413
  • Fax: 877-704-1444
Mailing address:
  • Phone: 612-418-4700
  • Fax: 612-926-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP0851
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP0851
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberLP0851
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: