Healthcare Provider Details

I. General information

NPI: 1831131051
Provider Name (Legal Business Name): TUESDAY A SHATTUCK LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/23/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 W 130TH ST SUITE 500
PARMA HEIGHTS OH
44130-7878
US

IV. Provider business mailing address

5255 N ABBE RD
SHEFFIELD VILLAGE OH
44035-1451
US

V. Phone/Fax

Practice location:
  • Phone: 440-842-6867
  • Fax: 440-842-8914
Mailing address:
  • Phone: 440-934-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0007981
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: