MEDICARE: MR. KARL RITCHIE SCHLOTTERBECK LP

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	103T00000X	Psychologist	LP1290	MN

General Provider Information

NPI Number	:	1861670226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KARL RITCHIE SCHLOTTERBECK LP

Provider Business Mailing Address
First Line	:	445 157TH AVE NE
Second Line	:
City	:	HAM LAKE
State	:	MN
Zip	:	55304-5513
Country	:	US
Telephone Number	:	763-434-3940
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 157TH AVE NE
Second Line	:
City	:	HAM LAKE
State	:	MN
Zip	:	55304-5513
Country	:	US
Telephone Number	:	763-434-3940
Fax Number	:

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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