Provider Demographics
NPI:1598542169
Name:SHAFFER, KATHREEN HOPE
Entity Type:Individual
Prefix:
First Name:KATHREEN
Middle Name:HOPE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 KATHERINE ST NW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-2731
Mailing Address - Country:US
Mailing Address - Phone:205-234-9282
Mailing Address - Fax:
Practice Address - Street 1:1420 KATHERINE ST NW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-2731
Practice Address - Country:US
Practice Address - Phone:205-234-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty