Individual
SUSAN LORENA SHADWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IMFT-S, LMFT, ATR-BC
Contact information
Practice address
628 WOODLAKE CT, WESTERVILLE, OH 43081-3458
(213) 631-3733
(614) 999-1306
Mailing address
628 WOODLAKE CT, WESTERVILLE, OH 43081-3458
(213) 631-3733
(614) 999-1306
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
F.1700016
OH
106H00000X
Marriage & Family Therapist
LMFT99844
CA
221700000X
Art Therapist
ART.24000031
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0232084
—
OH
Enumeration date
08/20/2014
Last updated
11/01/2024
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