Healthcare Provider Details

I. General information

NPI: 1972753630
Provider Name (Legal Business Name): SHALEAN KEMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12820 DARLINGTON AVE
GARFIELD HEIGHTS OH
44125-3759
US

IV. Provider business mailing address

12820 DARLINGTON AVE
GARFIELD HEIGHTS OH
44125-3759
US

V. Phone/Fax

Practice location:
  • Phone: 216-254-4577
  • Fax:
Mailing address:
  • Phone: 216-254-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0600074
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1600893
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801105366
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: