Provider Demographics
NPI:1366564312
Name:SHAKESPEARE, EDWARD E
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:SHAKESPEARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1817
Mailing Address - Country:US
Mailing Address - Phone:209-929-6700
Mailing Address - Fax:209-929-6704
Practice Address - Street 1:729 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1817
Practice Address - Country:US
Practice Address - Phone:209-929-6700
Practice Address - Fax:209-929-6704
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist