Provider Demographics
NPI:1275262776
Name:TOLEWITZ, SHELLY LYNN (LSW)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:TOLEWITZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 EAGLE PASS STE H
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-5357
Mailing Address - Country:US
Mailing Address - Phone:330-345-8970
Mailing Address - Fax:330-264-3777
Practice Address - Street 1:2148 EAGLE PASS STE H
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-5357
Practice Address - Country:US
Practice Address - Phone:330-345-8970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2208476101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor