Healthcare Provider Details

I. General information

NPI: 1508342528
Provider Name (Legal Business Name): SHANNON MARIE MAAG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

IV. Provider business mailing address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

V. Phone/Fax

Practice location:
  • Phone: 567-220-7018
  • Fax: 567-220-7012
Mailing address:
  • Phone: 567-220-7018
  • Fax: 567-220-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.161980
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0500302
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: