MEDICARE: MS. VICKI L SHAFFER M.S.W., L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149 008642	IL

General Provider Information

NPI Number	:	1063520039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI L SHAFFER M.S.W., L.C.S.W.

Provider Business Mailing Address
First Line	:	550W FRONTAGE RD 2730
Second Line	:
City	:	NORTHFIELD
State	:	IL
Zip	:	60093-1259
Country	:	US
Telephone Number	:	847-386-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	550W FRONTAGE RD 2730
Second Line	:
City	:	NORTHFIELD
State	:	IL
Zip	:	60093-1259
Country	:	US
Telephone Number	:	847-386-6070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	11/11/2015

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