Provider Demographics
NPI:1003353988
Name:FRAME, SHANNON E (LISW-S, LICDC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:FRAME
Suffix:
Gender:F
Credentials:LISW-S, LICDC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:E
Other - Last Name:HANJORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43216-1595
Mailing Address - Country:US
Mailing Address - Phone:937-869-1053
Mailing Address - Fax:
Practice Address - Street 1:11 GRAHAM DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1430
Practice Address - Country:US
Practice Address - Phone:800-321-8293
Practice Address - Fax:740-687-1048
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101187101YA0400X
OHI.1101044104100000X
OHS.09007621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0202831Medicaid