Healthcare Provider Details

I. General information

NPI: 1407449770
Provider Name (Legal Business Name): SHAWNA MARIE WISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 OHIO RIVER RD STE B
WHEELERSBURG OH
45694-1713
US

IV. Provider business mailing address

8308 OHIO RIVER RD STE B
WHEELERSBURG OH
45694-1713
US

V. Phone/Fax

Practice location:
  • Phone: 740-529-8328
  • Fax: 740-876-8854
Mailing address:
  • Phone: 740-529-1201
  • Fax: 740-876-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: