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1639832967
KELLY SHAFER
WASILLA, AK
NPI
1639832967
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2021-10-13
Last Update Date
2021-10-13
Business Address
KELLY SHAFER
7010 E BOGARD RD BLDG 2
WASILLA, AK 99654-4711
Phone number: 907-373-4732
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Mailing Address
KELLY SHAFER
PO BOX 876741
WASILLA, AK 99687-6741
Phone number: 907-373-4732
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