Shaffer, Sandra Marie

Shaffer, Sandra Marie is an sole proprietor health care provider with primary practice located at 3475 Omro Rd Ste 400 , Oshkosh WI 54904-7126. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Shaffer, Sandra Marie can be contacted via phone (920) 203-7565.

Contact Information

Primary practice address
3475 Omro Rd Ste 400 Oshkosh WI 54904-7126
Phone: (920) 203-7565
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 15806-132 Wisconsin
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 8484-123 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X 8484-123 Wisconsin

Profile Details

NPI number 1427228436
LBN Legal business name Shaffer, Sandra Marie
Credentials LCSW, CSAC, ICS
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 5th, 2008
Last updated Jan 7th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427228436 NPPES
Wisconsin MEDICAID 100102138
Wisconsin Other 1184230351

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