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NPI Code Detail

MEDICARE: SHANAE ALLEN LCDCIII

MEDICARE: SHANAE ALLEN LCDCIII
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093207938
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANAE ALLEN LCDCIII
Provider Business Mailing Address
First Line : 5122 GLENCROSSING WAY
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-3361
Country : US
Telephone Number : 513-827-9044
Fax Number : 513-832-1332
Provider Business Practice Location Address
First Line : 5122 GLENCROSSING WAY
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-3361
Country : US
Telephone Number : 513-827-9044
Fax Number : 513-832-1332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2018
Last Update Date : 06/16/2018

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