Provider Demographics
NPI:1699148643
Name:SHEA, JEANNE F (LISW-S)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:F
Last Name:SHEA
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S PORTAGE PATH
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2327
Mailing Address - Country:US
Mailing Address - Phone:330-253-4597
Mailing Address - Fax:330-253-4974
Practice Address - Street 1:415 S PORTAGE PATH
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2327
Practice Address - Country:US
Practice Address - Phone:330-253-4597
Practice Address - Fax:330-253-4974
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0002973104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker