Individual
SADIE DAWN SHAFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3552 LONE PINE RD, MEDFORD, OR 97504-5637
(541) 727-1592
Mailing address
3460 LAZY LN, WHITE CITY, OR 97503-1570
(541) 324-0061
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
831354508
—
OR
Enumeration date
09/14/2021
Last updated
09/14/2021
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