MEDICARE: SHALEAN KEMP

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	1041C0700X	Clinical Social Worker	I.1600893	OH
2	1041C0700X	Clinical Social Worker	6801105366	MI
3	104100000X	Social Worker	S.0600074	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I.1600893	OTHER	OH	LICENSED INDEPENDENT SOCIAL WORKER
2	6801105366	OTHER	MI	LICENSED CLINICAL SOCIAL WORKER
3	S.0600074	OTHER	OH	COUNSELOR

General Provider Information

NPI Number	:	1972753630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALEAN KEMP

Provider Business Mailing Address
First Line	:	12820 DARLINGTON AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3759
Country	:	US
Telephone Number	:	216-254-4577
Fax Number	:

Provider Business Practice Location Address
First Line	:	12820 DARLINGTON AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3759
Country	:	US
Telephone Number	:	216-254-4577
Fax Number	:

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

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	11/30/2021

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Directions to “ SHALEAN KEMP ” Practice Location

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