Individual
JOHNNY LEE SHAFFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 E PARK AVE, DU BOIS, PA 15801-2271
(814) 279-4823
Mailing address
25 E PARK AVE, DU BOIS, PA 15801-2271
(814) 279-4823
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH001561
PA
Other
Enumeration date
07/31/2019
Last updated
07/31/2019
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