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General NPI Number Information
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NPI Number | 1730807595
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Entity Type | Individual
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Provider Name | ALEESIA MAKENSI SHAW
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Gender | Female
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 2775 STATE ROUTE 39
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City | SHELBY
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State | OH
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Zip | 44875-9466
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Country | US
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Telephone | 419-747-3322
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Fax |
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Provider Business Mailing Address
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Address Line | 596 STRAUB RD W APT G
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City | MANSFIELD
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State | OH
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Zip | 44904-1865
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Country | US
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Telephone | 567-274-8786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.184260
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2302957-TRNE
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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