| Shawna Park Lisw-s, Llc | |
|
287 W Johnstown Rd Columbus OH 43230-2732 | |
| (216) 299-1517 | |
| Not Available |
| Full Name | Shawna Park Lisw-s, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 287 W Johnstown Rd, Columbus, Ohio |
| Authorized Official Name and Position | Shawna Park (OWNER) |
| Authorized Official Contact | 2162991517 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shawna Park Lisw-s, Llc 2327 Gavinley Way Columbus OH 43220-7335 Ph: (216) 299-1517 | Shawna Park Lisw-s, Llc 287 W Johnstown Rd Columbus OH 43230-2732 Ph: (216) 299-1517 |
| NPI Number | 1699164434 |
|---|---|
| Provider Enumeration Date | 01/16/2015 |
| Last Update Date | 01/16/2015 |
| Medicare PECOS PAC ID | 2466776588 |
|---|---|
| Medicare Enrollment ID | O20150121000572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699164434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 1101599 (Ohio) | Primary |
| Provider Name | Shawna Park |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679822084 PECOS PAC ID: 1658523899 Enrollment ID: I20121214000223 |
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