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General NPI Number Information
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NPI Number | 1730425042
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Entity Type | Individual
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Provider Name | PETER K SHAFER MS CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 25 TERRACE DR
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City | VANCOUVER
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State | WA
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Zip | 98661-5774
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Country | US
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Telephone | 360-694-6064
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Fax |
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Provider Business Mailing Address
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Address Line | 11405 NE 69TH ST
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City | VANCOUVER
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State | WA
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Zip | 98662-4817
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Country | US
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Telephone | 360-604-6975
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 439179C
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License Number State | WA
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