Individual
BRENDA NICHOLS SHAFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
740 FLORSHEIM DR STE 11, LIBERTYVILLE, IL 60048-3712
(781) 475-9785
Mailing address
740 FLORSHEIM DR STE 11, LIBERTYVILLE, IL 60048-3712
(781) 475-9785
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
05102420
IL
Other
Enumeration date
12/15/2023
Last updated
12/15/2023
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