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General NPI Number Information
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NPI Number | 1427228436
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Entity Type | Individual
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Provider Name | SANDRA MARIE SHAFFER LCSW, CSAC, ICS
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Gender | Female
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 3475 OMRO RD STE 400
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City | OSHKOSH
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State | WI
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Zip | 54904-7126
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Country | US
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Telephone | 920-203-7565
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Fax |
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Provider Business Mailing Address
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Address Line | 3475 OMRO RD STE 400
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City | OSHKOSH
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State | WI
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Zip | 54904-7126
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Country | US
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Telephone | 920-267-3470
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Fax | 920-267-3480
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15806-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8484-123
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8484-123
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License Number State | WI
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