Healthcare Provider Details

I. General information

NPI: 1083288195
Provider Name (Legal Business Name): SHAWN FINNERTY PRC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W LAKE LANSING RD STE 500
EAST LANSING MI
48823-1578
US

IV. Provider business mailing address

315 W LAKE LANSING RD STE 500
EAST LANSING MI
48823-1578
US

V. Phone/Fax

Practice location:
  • Phone: 517-657-3533
  • Fax: 517-580-0530
Mailing address:
  • Phone: 517-657-3533
  • Fax: 517-580-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801122911
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: