Provider Demographics
NPI:1225582182
Name:SHAFFER, JESSICA (CSW-PIP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 OYATE CIR
Mailing Address - Street 2:
Mailing Address - City:LOWER BRULE
Mailing Address - State:SD
Mailing Address - Zip Code:57548-8500
Mailing Address - Country:US
Mailing Address - Phone:605-208-0047
Mailing Address - Fax:605-473-8051
Practice Address - Street 1:187 OYATE CIR
Practice Address - Street 2:
Practice Address - City:LOWER BRULE
Practice Address - State:SD
Practice Address - Zip Code:57548-8500
Practice Address - Country:US
Practice Address - Phone:605-208-0047
Practice Address - Fax:605-473-8051
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD34151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical