=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851643597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA G SHIELER LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2012
-----------------------------------------------------
Last Update Date | 04/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 WELLNESS DR
-----------------------------------------------------
City | SUMMERSVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26651-5402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-872-2659
-----------------------------------------------------
Fax | 304-872-1685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 WELLNESS DR
-----------------------------------------------------
City | SUMMERSVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26651-5402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-872-6503
-----------------------------------------------------
Fax | 304-872-5415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | BP00942038
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | AP00942038
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | DP00942038
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------