Provider Demographics
NPI:1861725905
Name:SCHUMANN, NICOLE MARIE (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:SCHUMANN
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 PORTLAND AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6817
Mailing Address - Country:US
Mailing Address - Phone:952-236-6189
Mailing Address - Fax:952-213-6116
Practice Address - Street 1:12400 PORTLAND AVE STE 120
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6817
Practice Address - Country:US
Practice Address - Phone:952-236-6189
Practice Address - Fax:952-213-6116
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5456103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent