Provider Demographics
NPI:1306638317
Name:SHAFFER, AIDAN JAMES
Entity type:Individual
Prefix:
First Name:AIDAN
Middle Name:JAMES
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 LIBERTY ST NE STE 2
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2463
Mailing Address - Country:US
Mailing Address - Phone:503-589-3112
Mailing Address - Fax:
Practice Address - Street 1:805 LIBERTY ST NE STE 2
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2463
Practice Address - Country:US
Practice Address - Phone:503-589-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health