Provider Demographics
NPI:1578072484
Name:SHIVERDECKER, SARAH KAYEANN (LSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KAYEANN
Last Name:SHIVERDECKER
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 1:116 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:HOLLANSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45332-9709
Mailing Address - Country:US
Mailing Address - Phone:937-564-8232
Mailing Address - Fax:
Practice Address - Street 1:228 N BARRON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1704
Practice Address - Country:US
Practice Address - Phone:937-456-7694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600999104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker