Healthcare Provider Details

I. General information

NPI: 1154544336
Provider Name (Legal Business Name): DANA LAURIE SHAFER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 E US HIGHWAY 40 SUITE 140
INDEPENDENCE MO
64055-5450
US

IV. Provider business mailing address

2012 NE OVERLAND DR
GRAIN VALLEY MO
64029-8614
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-6761
  • Fax: 816-373-6591
Mailing address:
  • Phone: 816-805-7054
  • Fax: 816-373-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2006020635
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: