Individual
JEANNINE L. SHAFER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1216 W WILLOW RD, SUITE F, ENID, OK 73703-2532
(580) 234-6790
(580) 234-2993
Mailing address
1216 W WILLOW RD, SUITE F, ENID, OK 73703-2532
(580) 234-6790
(580) 234-2993
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2404
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7903086
AETNA
OK
Enumeration date
06/13/2006
Last updated
07/08/2007
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