MEDICARE: BRENNA SCHAFFER

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	LCSW-516	WY

General Provider Information

NPI Number	:	1497945380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA SCHAFFER

Provider Business Mailing Address
First Line	:	PO BOX 6005
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82931-6005
Country	:	US
Telephone Number	:	307-789-3710
Fax Number	:	307-789-0823

Provider Business Practice Location Address
First Line	:	195 FEATHER WAY STOP 1
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-9352
Country	:	US
Telephone Number	:	307-789-0715
Fax Number	:	307-789-4774

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

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	07/27/2007

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Directions to “ BRENNA SCHAFFER ” Practice Location

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