Healthcare Provider Details

I. General information

NPI: 1174856504
Provider Name (Legal Business Name): DENA MARIE SHAFER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENA MARIE BOFF LSW

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E WASHINGTON ST
NAPOLEON OH
43545-1698
US

IV. Provider business mailing address

1710 KIOWA CT
DEFIANCE OH
43512-3342
US

V. Phone/Fax

Practice location:
  • Phone: 419-592-0540
  • Fax: 419-592-4514
Mailing address:
  • Phone: 419-438-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS 0800498
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2102899
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: