Provider Demographics
NPI:1841937448
Name:NAIK, SHANNON REBECCA (LISW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:REBECCA
Last Name:NAIK
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 STRETCH DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45434-5644
Mailing Address - Country:US
Mailing Address - Phone:937-671-1316
Mailing Address - Fax:
Practice Address - Street 1:1525 STRETCH DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45434-5644
Practice Address - Country:US
Practice Address - Phone:937-671-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22036031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical