Provider Demographics
NPI:1609141092
Name:PERRY, SHANNON MONE'T (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MONE'T
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:MONE'T
Other - Last Name:CLARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24654
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-0654
Mailing Address - Country:US
Mailing Address - Phone:248-905-4553
Mailing Address - Fax:
Practice Address - Street 1:4100 W. THIRD ST.
Practice Address - Street 2:BUILDING 409 SUITE 113
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010691861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical