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General NPI Number Information
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NPI Number | 1386073583
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Entity Type | Individual
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Provider Name | MRS. BONNIE SHAFFER
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 40880 PEDDER RD.
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City | BIG BEAR LAKE
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State | CA
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Zip | 92315
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Country | US
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Telephone | 909-366-0545
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Fax | 909-366-0545
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Provider Business Mailing Address
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Address Line | PO BOX 578
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City | SKYFOREST
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State | CA
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Zip | 92385-0578
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Country | US
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Telephone | 909-366-0545
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Fax | 909-366-0545
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | RI-S1307181042
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License Number State | CA
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