MEDICARE: MS. KIMBERLY MEG SHEWMAKER LMSW, CAADC, CCDP-D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	10004	MI
2	1041C0700X	Clinical Social Worker	6801070706	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215118138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY MEG SHEWMAKER LMSW, CAADC, CCDP-D

Provider Business Mailing Address
First Line	:	529 M L KING AVE
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48502-2002
Country	:	US
Telephone Number	:	810-238-7226
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 M L KING AVE
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48502-2002
Country	:	US
Telephone Number	:	810-238-7226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	02/17/2022

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