MEDICARE: SHAWNIEKA EVETT POPE MSW, LISW, LCSW

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	1041C0700X	Clinical Social Worker	I.2102838	OH

General Provider Information

NPI Number	:	1770257503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNIEKA EVETT POPE MSW, LISW, LCSW

Provider Business Mailing Address
First Line	:	3532 WALES DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1843
Country	:	US
Telephone Number	:	317-652-7360
Fax Number	:

Provider Business Practice Location Address
First Line	:	3532 WALES DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1843
Country	:	US
Telephone Number	:	317-652-7360
Fax Number	:

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

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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