MEDICARE: MRS. LISA L SHEHAN LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker	S.0900977	OH

General Provider Information

NPI Number	:	1225241599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA L SHEHAN LSW

Provider Business Mailing Address
First Line	:	470 TOWNSHIP ROAD 1101
Second Line	:
City	:	NOVA
State	:	OH
Zip	:	44859-9737
Country	:	US
Telephone Number	:	419-652-2375
Fax Number	:	419-281-4605

Provider Business Practice Location Address
First Line	:	470 TOWNSHIP ROAD 1101
Second Line	:
City	:	NOVA
State	:	OH
Zip	:	44859-9737
Country	:	US
Telephone Number	:	419-652-2375
Fax Number	:	419-281-4605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/19/2010

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