Provider Demographics
NPI:1558768606
Name:SCHAFFER, JOHN (PC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SCHAFFER
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 MCKINLEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-2463
Mailing Address - Country:US
Mailing Address - Phone:330-455-9407
Mailing Address - Fax:330-430-1288
Practice Address - Street 1:832 MCKINLEY AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-2463
Practice Address - Country:US
Practice Address - Phone:330-455-9407
Practice Address - Fax:330-430-1288
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health