Provider Demographics
NPI:1326089335
Name:SHAFFER, DYANA MARIA (CSW,MSW)
Entity Type:Individual
Prefix:MS
First Name:DYANA
Middle Name:MARIA
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:CSW,MSW
Other - Prefix:MS
Other - First Name:DYANA
Other - Middle Name:MARIA
Other - Last Name:GUILFORD-SHAFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSW,MSWLSW
Mailing Address - Street 1:1947 PORTAGE PATH
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-3333
Mailing Address - Country:US
Mailing Address - Phone:937-325-3157
Mailing Address - Fax:937-322-8528
Practice Address - Street 1:512 S BURNETT RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2720
Practice Address - Country:US
Practice Address - Phone:180-036-8826
Practice Address - Fax:937-322-8528
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW00000064771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical