Healthcare Provider Details

I. General information

NPI: 1992345656
Provider Name (Legal Business Name): SHAYLEE LARUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 DEERFIELD RD
LEBANON OH
45036-9946
US

IV. Provider business mailing address

1879 DEERFIELD RD
LEBANON OH
45036-9946
US

V. Phone/Fax

Practice location:
  • Phone: 513-695-2900
  • Fax: 513-809-1008
Mailing address:
  • Phone: 513-695-2900
  • Fax: 513-809-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2106980
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: