Provider Demographics
NPI:1427220599
Name:SHAFFER, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:2228 N 52ND ST
Mailing Address - Street 2:241
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-3443
Mailing Address - Country:US
Mailing Address - Phone:623-229-2900
Mailing Address - Fax:
Practice Address - Street 1:24654 N LAKE PLEASANT PKWY # 103-704
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1359
Practice Address - Country:US
Practice Address - Phone:623-229-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-29
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ39278962355S0801X
BACB268596103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant