Individual
JACOB GREGORY SHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 N BROAD ST, MANKATO, MN 56001-3585
(507) 828-6332
Mailing address
1400 WARREN ST APT H32, MANKATO, MN 56001-6912
(507) 828-6332
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
306194
MN
Other
Enumeration date
10/07/2021
Last updated
10/07/2021
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