Provider Demographics
NPI:1598478265
Name:CLARK, SHIAUNA N
Entity Type:Individual
Prefix:
First Name:SHIAUNA
Middle Name:N
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 E MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-1415
Mailing Address - Country:US
Mailing Address - Phone:513-205-3449
Mailing Address - Fax:
Practice Address - Street 1:829 E MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-1415
Practice Address - Country:US
Practice Address - Phone:513-205-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional