Healthcare Provider Details

I. General information

NPI: 1326089335
Provider Name (Legal Business Name): DYANA MARIA SHAFFER CSW,MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DYANA MARIA GUILFORD-SHAFFER CSW,MSW.LSW

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 S BURNETT RD
SPRINGFIELD OH
45505-2720
US

IV. Provider business mailing address

1947 PORTAGE PATH
SPRINGFIELD OH
45506-3333
US

V. Phone/Fax

Practice location:
  • Phone: 180-036-8826
  • Fax: 937-322-8528
Mailing address:
  • Phone: 937-325-3157
  • Fax: 937-322-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW0000006477
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: