Provider Demographics
NPI:1578875753
Name:SHAFFER, ASHLEIGH MAE BREWER (MMT, MT-BC, BCBA)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:MAE BREWER
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MMT, MT-BC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 ALLENTOWN BLVD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-4237
Mailing Address - Country:US
Mailing Address - Phone:717-919-8022
Mailing Address - Fax:
Practice Address - Street 1:7540 ALLENTOWN BLVD
Practice Address - Street 2:UNIT 5
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-4237
Practice Address - Country:US
Practice Address - Phone:717-919-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-10-6973103K00000X
PA08210225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist