Healthcare Provider Details

I. General information

NPI: 1225578917
Provider Name (Legal Business Name): SHANNON BURKE MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ELSINORE PL STE 500
CINCINNATI OH
45202-1455
US

IV. Provider business mailing address

615 ELSINORE PL STE 500
CINCINNATI OH
45202-1455
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-6630
  • Fax:
Mailing address:
  • Phone: 513-889-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.190651
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberI.190651
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: