Healthcare Provider Details

I. General information

NPI: 1508282641
Provider Name (Legal Business Name): SHANNON JENNIE ELAINE BROWN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 WEST BIG BEAVER SUITE 1450
TROY MI
48084
US

IV. Provider business mailing address

2947 MOHAWK CIR
ROCHESTER HILLS MI
48306-3828
US

V. Phone/Fax

Practice location:
  • Phone: 248-244-8644
  • Fax:
Mailing address:
  • Phone: 734-883-3721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801084937
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: