Provider Demographics
NPI:1174856504
Name:SHAFER, DENA MARIE (LSW)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:MARIE
Last Name:SHAFER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:MARIE
Other - Last Name:BOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1710 KIOWA CT
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-3342
Mailing Address - Country:US
Mailing Address - Phone:419-438-3319
Mailing Address - Fax:
Practice Address - Street 1:219 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1698
Practice Address - Country:US
Practice Address - Phone:419-592-0540
Practice Address - Fax:419-592-4514
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.21028991041C0700X
OHS 0800498104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker