Provider Demographics
NPI:1902820160
Name:JOHNSON, SHEILA RUTH (ACSW, LISW, LICDC)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:RUTH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ACSW, LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7776 LAURA ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-7819
Mailing Address - Country:US
Mailing Address - Phone:330-854-2903
Mailing Address - Fax:
Practice Address - Street 1:4888 ARMANDALE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2284
Practice Address - Country:US
Practice Address - Phone:330-454-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00040641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJOSW21171Medicare PIN