Healthcare Provider Details

I. General information

NPI: 1477881381
Provider Name (Legal Business Name): CHERYL ANN SHEPARD LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 W CENTRAL AVE
TOLEDO OH
43617-1000
US

IV. Provider business mailing address

439 CLOVER LN
ARCHBOLD OH
43502-3218
US

V. Phone/Fax

Practice location:
  • Phone: 419-841-7701
  • Fax: 419-841-1691
Mailing address:
  • Phone: 419-388-1896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0800328
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1500411-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: