Susan Lorena Shadwick, IMFT-S, LMFT, ATR-BC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

F.1700016 Issued in OH

Practice address

628 Woodlake CT
Westerville, OH 43081-3458

Phone

(213) 631-3733

Fax

(614) 999-1306

NPI assigned

Aug 20, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Susan Lorena Snodgrass Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 6, 2024 through Jul 6, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1043619554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 WOODLAKE CT",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430813458",
            "telephone_number": "213-631-3733",
            "fax_number": "614-999-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 WOODLAKE CT",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430813458",
            "telephone_number": "213-631-3733",
            "fax_number": "614-999-1306"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1491 Polaris Pkwy # 147",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432402041",
            "country_code": "US",
            "telephone_number": "213-631-3733",
            "fax_number": "614-999-1306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHADWICK",
        "first_name": "SUSAN",
        "middle_name": "LORENA",
        "credential": "IMFT-S, LMFT, ATR-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-20",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT99844",
            "primary": false
        },
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": "OH",
            "license": "ART.24000031",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OH",
            "license": "F.1700016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0232084",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "SNODGRASS",
            "middle_name": "LORENA",
            "credential": "IMFT-S, LMFT, ATR-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jalane Sernessa
• Isatu Memuna Sesay, RN
• Shackle LLC
• Hadijat Shado
• Jonathan Shado, STNA.
• Catherine Shaffer, BCBA/COBA
• Dean Shaffer
• Jill Shaffer
• Megan Shaffer, LISW
• Ketul K Shah, MD

• Marriage & Family Therapist in Westerville, OH
• Providers in Westerville, OH by specialty
• Marriage & Family Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.