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NPI Code Detail

MEDICARE: MRS. SHANNON L HOLB LISW-S

MEDICARE: MRS. SHANNON L HOLB LISW-S
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
11041C0700XClinical Social WorkerI 1440400 SOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619151289
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON L HOLB LISW-S
Provider Business Mailing Address
First Line : 5109 W BROAD ST STE 104
Second Line :
City : COLUMBUS
State : OH
Zip : 43228-1648
Country : US
Telephone Number : 614-279-7690
Fax Number :
Provider Business Practice Location Address
First Line : 246 NORTHLAND DR STE 200A
Second Line :
City : MEDINA
State : OH
Zip : 44256-3440
Country : US
Telephone Number : 330-725-9195
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2007
Last Update Date : 02/14/2020

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