Provider Demographics
NPI:1154544336
Name:SHAFER, DANA LAURIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LAURIE
Last Name:SHAFER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 NE OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-8614
Mailing Address - Country:US
Mailing Address - Phone:816-805-7054
Mailing Address - Fax:816-373-6591
Practice Address - Street 1:19401 E US HIGHWAY 40
Practice Address - Street 2:SUITE 140
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5450
Practice Address - Country:US
Practice Address - Phone:816-373-6761
Practice Address - Fax:816-373-6591
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060206351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical