Provider Demographics
NPI:1174281570
Name:STIVERS, SHYAN SUE (MSW, CSW, LSW)
Entity Type:Individual
Prefix:
First Name:SHYAN
Middle Name:SUE
Last Name:STIVERS
Suffix:
Gender:F
Credentials:MSW, CSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11590 CENTURY BLVD STE 116
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3317
Practice Address - Country:US
Practice Address - Phone:513-771-7239
Practice Address - Fax:513-771-7240
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2560191041C0700X
OHS.2207211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical