Provider Demographics
NPI:1497362537
Name:SCHAEFFER, SHANNON LEIGH (MRC, TLMHC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:MRC, TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461-1712
Mailing Address - Country:US
Mailing Address - Phone:563-203-0684
Mailing Address - Fax:
Practice Address - Street 1:100 1ST ST NE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3302
Practice Address - Country:US
Practice Address - Phone:563-203-0684
Practice Address - Fax:319-483-6661
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101747101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14962552OtherCAQH