Healthcare Provider Details

I. General information

NPI: 1265357529
Provider Name (Legal Business Name): MARY-REBECCA SHINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY SHINN

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 BUSENBARK RD
TRENTON OH
45067-7611
US

IV. Provider business mailing address

3045 BUSENBARK RD
TRENTON OH
45067-7611
US

V. Phone/Fax

Practice location:
  • Phone: 513-867-6314
  • Fax: 513-867-6341
Mailing address:
  • Phone: 513-867-6314
  • Fax: 513-867-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.02524
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: