Provider Demographics
NPI:1023268059
Name:STRUNK, SHANE T (LISW-S)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:T
Last Name:STRUNK
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6612
Mailing Address - Country:US
Mailing Address - Phone:513-891-0650
Mailing Address - Fax:513-891-2838
Practice Address - Street 1:4240 HUNT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-6612
Practice Address - Country:US
Practice Address - Phone:513-891-0650
Practice Address - Fax:513-891-2838
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0800218.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical