| NPI | 1255722500 |
|---|---|
| Former Name | STACI SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1500936-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH S.1201024) |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2026-05-12 |