Basic Information
| Provider Information | |||||||||
| NPI: | 1225185093 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOULDERS | ||||||||
| FirstName: | D | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1580 ROYAL OAK DR | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449063529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197568646 | ||||||||
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| Practice Location | |||||||||
| Address1: | 270 STERKEL BLVD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449071508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197561133 | ||||||||
| FaxNumber: | 4197566544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S-0028839 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.