Provider Demographics
NPI:1194265868
Name:MILLER, SHANNON (LLMSW)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 W MARQUETTE WOODS RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9586
Mailing Address - Country:US
Mailing Address - Phone:269-934-0723
Mailing Address - Fax:
Practice Address - Street 1:2245 W MARQUETTE WOODS RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9586
Practice Address - Country:US
Practice Address - Phone:269-934-0723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010993181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical