Healthcare Provider Details

I. General information

NPI: 1326529686
Provider Name (Legal Business Name): SHAWNA PARM CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 EVANS ST STE 104
CINCINNATI OH
45204-2075
US

IV. Provider business mailing address

801 EVANS ST STE 104
CINCINNATI OH
45204-2075
US

V. Phone/Fax

Practice location:
  • Phone: 513-903-6559
  • Fax: 513-279-3161
Mailing address:
  • Phone: 513-903-6559
  • Fax: 513-279-3161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.181847
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.003447
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: