Provider Demographics
NPI:1649839481
Name:SHAFER, DEANNA (LISW)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:
Last Name:SHAFER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 KIMBALL AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5731
Mailing Address - Country:US
Mailing Address - Phone:319-408-8530
Mailing Address - Fax:319-205-4515
Practice Address - Street 1:3606 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5731
Practice Address - Country:US
Practice Address - Phone:319-408-8530
Practice Address - Fax:319-205-4515
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0951921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074435Medicaid