Provider Demographics
NPI:1770293565
Name:SHANNON, AIMEE L (LICENSED SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:L
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LICENSED SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S STANFIELD RD STE C
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3689
Mailing Address - Country:US
Mailing Address - Phone:937-787-6859
Mailing Address - Fax:
Practice Address - Street 1:110 S STANFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3689
Practice Address - Country:US
Practice Address - Phone:937-787-6859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00195221041C0700X
OHS.0019522104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker