Shawna Jackson Young, LCDC III, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.1801043 Issued in OH

Practice address

24100 Chagrin Blvd Ste 330
Beachwood, OH 44122

Phone

(216) 990-8773

NPI assigned

Jun 8, 2016

Last updated

Jun 23, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Theodicies Support LLC

  • Clinical Social Worker
  • Beachwood, OH
  • NPI 1083323430
  NPD Authorized official

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

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529712000000",
    "number": "1710336896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13605 CAINE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441056335",
            "telephone_number": "216-990-8773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24100 CHAGRIN BLVD STE 330",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "44122",
            "telephone_number": "216-990-8773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON YOUNG",
        "first_name": "SHAWNA",
        "credential": "LCDC III, LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-08",
        "last_updated": "2018-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LCDCIII.161563",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1600353",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1801043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liudmyla Ivakhiv, QMHS-M
• Angela Marie Ivancic, LISW-S
• Izzeldin Izheman
• Jack J. Lesyk, PH.D., Inc.
• Jack Rzepka, M.D., Inc.
• Aisha Marie Jackson, SWA
• Arvesha Jackson, MSW, LISW
• Brandon Jackson
• Katherine Jackson, PH.D., ATR-BC
• O'Sha D Jackson

• Clinical Social Worker in Beachwood, OH
• Providers in Beachwood, 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 Jun 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.