Provider Demographics
NPI:1306237680
Name:SNIDER, SHANNON (LMSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SNIDER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:866-611-1512
Mailing Address - Fax:231-728-4789
Practice Address - Street 1:5656 W US HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2454
Practice Address - Country:US
Practice Address - Phone:231-843-2543
Practice Address - Fax:231-843-2547
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010957781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical