Provider Demographics
NPI:1144495391
Name:SCHLACK, DAVID EDWARD (LADC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EDWARD
Last Name:SCHLACK
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:EDWARD
Other - Last Name:SCHLACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LUTH PASTOR M OF DIV
Mailing Address - Street 1:1326 EAST RIPLEY STREET
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355
Mailing Address - Country:US
Mailing Address - Phone:320-593-0440
Mailing Address - Fax:320-543-0442
Practice Address - Street 1:1326 EAST RIPLEY STREET
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355
Practice Address - Country:US
Practice Address - Phone:320-593-0440
Practice Address - Fax:320-543-0442
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300543103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)