Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301007747 | MI |
NPI | 1477711182 |
---|---|
Provider Name | William S Shauman |
First Address | Kalamazoo, MI 49007 |
Second Address | Kalamazoo, MI 49007-4711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 29/05/2008 |