Provider Demographics
NPI:1730425042
Name:SHAFER, PETER K (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:K
Last Name:SHAFER
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11405 NE 69TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-4817
Mailing Address - Country:US
Mailing Address - Phone:360-604-6975
Mailing Address - Fax:
Practice Address - Street 1:25 TERRACE DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-5774
Practice Address - Country:US
Practice Address - Phone:360-694-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA439179C235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist