Provider Demographics
NPI:1912731803
Name:RANSOM, SHONNETTA L
Entity type:Individual
Prefix:MS
First Name:SHONNETTA
Middle Name:L
Last Name:RANSOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 COLORADO AVE # 83
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3315
Mailing Address - Country:US
Mailing Address - Phone:440-650-8667
Mailing Address - Fax:
Practice Address - Street 1:860 COLORADO AVE # 83
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3315
Practice Address - Country:US
Practice Address - Phone:440-650-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service