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Individual
SHANE DESMITH
Active
Individual
SHANE DESMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
S.2309105
OH
175T00000X
Peer Specialist
0001988
OH
Other
Enumeration date
12/08/2017
Last updated
06/06/2024
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