Individual
MS. SANDRA MARIE SHAFFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CSAC, ICS
Contact information
Practice address
3475 OMRO RD STE 400, OSHKOSH, WI 54904-7126
(920) 203-7565
Mailing address
3475 OMRO RD STE 400, OSHKOSH, WI 54904-7126
(920) 267-3470
(920) 267-3480
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15806-132
WI
101YM0800X
Mental Health Counselor
8484-123
WI
1041C0700X
Clinical Social Worker
Primary
8484-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100102138
—
WI
01
—
1184230351
NPI-TYPE 2
WI
Enumeration date
03/05/2008
Last updated
01/07/2021
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