Jacob Gregory Shaffer

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

306194 Issued in MN

Practice address

201 N Broad St
Mankato, MN 56001-3585

Phone

(507) 828-6332

NPI assigned

Oct 7, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1922760842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 WARREN ST APT H32",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016912",
            "telephone_number": "507-828-6332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N BROAD ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560013585",
            "telephone_number": "507-828-6332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "JACOB",
        "middle_name": "GREGORY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-07",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "306194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Esther Sexton
• Patrick James Sexton I, ATC, ATR
• John William Seymour, PHD, LMFT
• Samantha Kaye Seys, DMD
• Anthony Shabrack, PMHNP-BC
• Valeed A Shaikh, MD
• Jordyn Shanks, MS., CCC-SLP
• Manish Singh Sharma, MBBS
• Jayd Ann Sharpe
• Rebecca Sue Sharpsteen, LICSW

• Addiction (Substance Use Disorder) Counselor in Mankato, MN
• Providers in Mankato, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.