Provider Demographics
NPI:1366186272
Name:SHAW, MEGAN RENEE (PRSS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:SHAW
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27750 STATE ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-5147
Mailing Address - Country:US
Mailing Address - Phone:740-374-5476
Mailing Address - Fax:
Practice Address - Street 1:27750 STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-5147
Practice Address - Country:US
Practice Address - Phone:740-374-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
OHCDCA.181958101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach