Provider Demographics
NPI:1902192339
Name:SHAFER, CARISSA LEE (SLP/CFY)
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:LEE
Last Name:SHAFER
Suffix:
Gender:F
Credentials:SLP/CFY
Other - Prefix:MISS
Other - First Name:CARISSA
Other - Middle Name:LEE
Other - Last Name:WIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP/CFY
Mailing Address - Street 1:143 MERRIMON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1815
Mailing Address - Country:US
Mailing Address - Phone:828-254-8889
Mailing Address - Fax:828-254-8887
Practice Address - Street 1:143 MERRIMON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1815
Practice Address - Country:US
Practice Address - Phone:828-254-8889
Practice Address - Fax:828-254-8887
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist