Provider Demographics
NPI:1124891676
Name:SHAFFER, PEYTON D (LMSW)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:D
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-3520
Mailing Address - Country:US
Mailing Address - Phone:913-602-0246
Mailing Address - Fax:
Practice Address - Street 1:7101 COLLEGE BLVD STE 1620
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2825
Practice Address - Country:US
Practice Address - Phone:913-744-1709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13159104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker