Provider Demographics
NPI:1568696433
Name:SHANK, SHANNA N (COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:N
Last Name:SHANK
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:MRS
Other - First Name:SHANNA
Other - Middle Name:N
Other - Last Name:SHANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:901 WAHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-355-8606
Mailing Address - Fax:740-353-1662
Practice Address - Street 1:901 WASHINGTON STRRET
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-355-8606
Practice Address - Fax:740-353-1662
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1600085-SUPV101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional