Provider Demographics
NPI:1972753630
Name:KEMP, SHALEAN
Entity Type:Individual
Prefix:
First Name:SHALEAN
Middle Name:
Last Name:KEMP
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 1:12820 DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3759
Mailing Address - Country:US
Mailing Address - Phone:216-254-4577
Mailing Address - Fax:
Practice Address - Street 1:12820 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3759
Practice Address - Country:US
Practice Address - Phone:216-254-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16008931041C0700X
MI68011053661041C0700X
OHS.0600074104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.1600893OtherLICENSED INDEPENDENT SOCIAL WORKER
MI6801105366OtherLICENSED CLINICAL SOCIAL WORKER
OHS.0600074OtherCOUNSELOR