Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP6662 | MN |
Y | 103T00000X | Psychologist | LP6662 | MN |
N | 103TC1900X | Counseling Psychologist | LP6662 | MN |
NPI | 1003401308 |
---|---|
Provider Name | Peter Mccormick Schaub |
First Address | Bloomington, MN 55425-4516 |
Second Address | St Louis Park, MN 55416-2527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2021 |
Last Update Date | 07/06/2021 |