MEDICARE: MELISSA ANNE SHANNON LPC

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
1	104100000X	Social Worker	C-0800047	OH

General Provider Information

NPI Number	:	1326295007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANNE SHANNON LPC

Provider Business Mailing Address
First Line	:	4721 READING RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-6107
Country	:	US
Telephone Number	:	513-242-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	9018 CINTI COLUMBUS RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3565
Country	:	US
Telephone Number	:	513-755-8133
Fax Number	:	513-755-8185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	02/06/2018

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