Provider Demographics
NPI:1386044618
Name:SHUMAKER, KEILAH (EDS)
Entity Type:Individual
Prefix:MRS
First Name:KEILAH
Middle Name:
Last Name:SHUMAKER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:MS
Other - First Name:KEILAH
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3048 BREMEN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-4366
Mailing Address - Country:US
Mailing Address - Phone:740-412-7169
Mailing Address - Fax:
Practice Address - Street 1:1930 CROWN PARK CT STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-2402
Practice Address - Country:US
Practice Address - Phone:614-695-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3089284103TS0200X
OHSP00647103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool