Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6801087727 | MI |
NPI | 1003051202 |
---|---|
Provider Name | Shadena Patrice Shipman |
First Address | Saginaw, MI 48602-4751 |
Second Address | Saginaw, MI 48602-4751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2008 |
Last Update Date | 03/02/2016 |