Provider Demographics
NPI:1225522279
Name:STILLWELL, SHAWNA (IMFT MA)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:IMFT MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 POLARIS PKWY STE 325
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-4085
Mailing Address - Country:US
Mailing Address - Phone:216-307-4229
Mailing Address - Fax:877-503-6591
Practice Address - Street 1:1554 POLARIS PKWY STE 325
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4085
Practice Address - Country:US
Practice Address - Phone:216-307-4229
Practice Address - Fax:877-503-6591
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2025-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.2000147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist