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General NPI Number Information
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NPI Number | 1982567426
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Entity Type | Individual
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Provider Name | KRISTIN SHUCKEROW
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 7750 20TH AVE
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City | JENISON
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State | MI
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Zip | 49428-8524
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Country | US
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Telephone | 616-341-2997
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Fax |
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Provider Business Mailing Address
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Address Line | 11670 SUNDROP CIR
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City | ALLENDALE
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State | MI
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Zip | 49401-8443
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Country | US
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Telephone | 989-317-6911
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Fax | 989-317-6911
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | MI
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