Healthcare Provider Details

I. General information

NPI: 1215849252
Provider Name (Legal Business Name): ANN MARIE SHAW LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 BROWNS LAKE RD
JACKSON MI
49201-8379
US

IV. Provider business mailing address

415 MCCLELLAN ST
HUDSON MI
49247-1131
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-5200
  • Fax:
Mailing address:
  • Phone: 517-442-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092200
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801092200
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: