Provider Demographics
NPI:1922538594
Name:SHAFFER, JORI ANN (CADC-II, ICADC)
Entity Type:Individual
Prefix:MS
First Name:JORI
Middle Name:ANN
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:CADC-II, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5836 DUDLEY BLVD.
Mailing Address - Street 2:#217
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6403
Mailing Address - Country:US
Mailing Address - Phone:916-452-3073
Mailing Address - Fax:916-452-1565
Practice Address - Street 1:3600 POWER INN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3826
Practice Address - Country:US
Practice Address - Phone:916-452-3073
Practice Address - Fax:916-452-1565
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA022630316101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)