Provider Demographics
NPI:1275626996
Name:PERKINS, SHANNON J (PHD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:J
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:J
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:PO BOX 2090
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-996-8603
Mailing Address - Fax:330-996-8695
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:SUITE 260
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-375-6590
Practice Address - Fax:330-375-6593
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5907103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2373015Medicaid
OHCP28704OtherMEDICARE ID