Provider Demographics
NPI:1487163028
Name:MCLAUGHLIN, SHANNON MARIE
Entity type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:MARIE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BORGESS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2702
Mailing Address - Country:US
Mailing Address - Phone:734-735-1880
Mailing Address - Fax:
Practice Address - Street 1:30000 HIVELEY ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1089
Practice Address - Country:US
Practice Address - Phone:734-728-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst