Healthcare Provider Details

I. General information

NPI: 1316678345
Provider Name (Legal Business Name): SHAYLEE ACKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WALNUT ST
COSHOCTON OH
43812-1655
US

IV. Provider business mailing address

610 WALNUT ST
COSHOCTON OH
43812-1655
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-0033
  • Fax: 740-622-0210
Mailing address:
  • Phone: 740-622-0033
  • Fax: 740-622-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.183190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: