Shannon Rae Speaks, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.0900288-SUPV Issued in OH

Practice address

56 Milford Dr
Hudson, OH 44236-2704

Phone

(216) 245-5213

NPI assigned

Jul 22, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kelly Reeves Memorial FoundationGroup PAC ID 2961885314, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kelly Reeves Memorial Foundation

  • Professional Counselor
  • Kent, OH
  • NPI 1295220986
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1073122313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6933 SAINT REGIS BLVD",
            "city": "HUDSON",
            "state": "OH",
            "postal_code": "442363224",
            "telephone_number": "330-554-1196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 MILFORD DR",
            "city": "HUDSON",
            "state": "OH",
            "postal_code": "442362704",
            "telephone_number": "216-245-5213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2275 State Route 59",
            "address_purpose": "LOCATION",
            "city": "Kent",
            "state": "OH",
            "postal_code": "442407143",
            "country_code": "US",
            "telephone_number": "330-593-5959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPEAKS",
        "first_name": "SHANNON",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-22",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.0900288-SUPV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO COUNSELOR, SOCIAL WORKER & MARRIAGE AND FAMILY THERAPIST BOARD",
            "identifier": "I.0900288-SUPV",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Jan Smith, APRN
• Lindsay Smith
• Richard D Smith, LPCC
• Dawnel Snyder, LPCC
• Victoria Marie Sondej, OTR/L, CSRS
• Erin Elizabeth Spies, D.O.
• Vanessa Spinelli
• Lauren Stackpole, APRN, CNP
• Kathleen Powers Stafford, PH.D.
• Jayme Leigh Stauffer

• Clinical Social Worker in Hudson, OH
• Providers in Hudson, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.