Provider Demographics
NPI:1831255181
Name:SHAFFAR, ELEANOR
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:SHAFFAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:238 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CASHTON
Mailing Address - State:WI
Mailing Address - Zip Code:54619-2002
Mailing Address - Country:US
Mailing Address - Phone:608-654-5100
Mailing Address - Fax:608-654-5120
Practice Address - Street 1:238 FRONT ST
Practice Address - Street 2:
Practice Address - City:CASHTON
Practice Address - State:WI
Practice Address - Zip Code:54619-2002
Practice Address - Country:US
Practice Address - Phone:608-654-5100
Practice Address - Fax:608-654-5120
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3377-125101YP2500X
WI473-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)