Basic Information
| Provider Information | |||||||||
| NPI: | 1497283600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOENFELT | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 634 SHERWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449041740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195640476 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17606 COSHOCTON RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430509218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403921450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2017 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S1700449 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | S.1700449 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.