Provider Demographics
NPI:1992928634
Name:TAYLOR, SHANNA LEAH (LISW-S)
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:LEAH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:LEAH
Other - Last Name:STORCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-291-1801
Mailing Address - Fax:419-882-8456
Practice Address - Street 1:1806 MADISON AVE FL 4
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5460
Practice Address - Country:US
Practice Address - Phone:419-291-1801
Practice Address - Fax:419-882-8456
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI101681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0338917Medicaid
MI1992928634Medicaid