Healthcare Provider Details

I. General information

NPI: 1710371497
Provider Name (Legal Business Name): SHANNON HELLMAN MSSA, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DIXIE DR
DAYTON OH
45409-1539
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 937-853-9061
  • Fax: 419-853-9069
Mailing address:
  • Phone: 419-695-8010
  • Fax: 419-695-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1302886
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: