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Individual
MRS. MISTY SUE SHIELDS
Active
Individual
MRS. MISTY SUE SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.W., L.C.S.W
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
SW126028
PA
1041C0700X
Clinical Social Worker
Primary
CW016341
PA
174400000X
Specialist
CW016341
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440088
—
PA
05
—
328834A336348
—
PA
Enumeration date
11/30/2005
Last updated
07/15/2021
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