Healthcare Provider Details

I. General information

NPI: 1699334953
Provider Name (Legal Business Name): VICTORIA SHIELDS LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N GRANT AVE
COLUMBUS OH
43215-2641
US

IV. Provider business mailing address

500 W WILSON BRIDGE RD STE 245
WORTHINGTON OH
43085-2283
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-0747
  • Fax: 855-208-4527
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: