Provider Demographics
NPI:1639888720
Name:SHAFFER, JADE RENEE
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:RENEE
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 1:423 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-1642
Mailing Address - Country:US
Mailing Address - Phone:925-325-1795
Mailing Address - Fax:
Practice Address - Street 1:1210 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2242
Practice Address - Country:US
Practice Address - Phone:925-809-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst