Healthcare Provider Details

I. General information

NPI: 1639088826
Provider Name (Legal Business Name): SHANNON KNECE PEER SUPPORT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 GEORGE WASHINGTON BLVD
AKRON OH
44312-3049
US

IV. Provider business mailing address

589 KOERBER AVE
AKRON OH
44314-1767
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax: 800-480-7578
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.008248
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: