Healthcare Provider Details

I. General information

NPI: 1083106371
Provider Name (Legal Business Name): SHAWANNA BAKER CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 ANSEL RD
CLEVELAND OH
44108-3323
US

IV. Provider business mailing address

560 WALNUT DR
EUCLID OH
44132-2116
US

V. Phone/Fax

Practice location:
  • Phone: 216-421-0662
  • Fax: 844-593-7239
Mailing address:
  • Phone: 216-800-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.170465
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: