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NPI Code Detail

MEDICARE: SHANNON EMERSON

MEDICARE:   SHANNON  EMERSON
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
1104100000XSocial Worker6803085514MI

General Provider Information

NPI Number : 1417285016
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON EMERSON
Provider Business Mailing Address
First Line : 1225 E BIG BEAVER RD
Second Line :
City : TROY
State : MI
Zip : 48083-1905
Country : US
Telephone Number : 248-524-8801
Fax Number : 248-524-8875
Provider Business Practice Location Address
First Line : 1225 E BIG BEAVER RD
Second Line :
City : TROY
State : MI
Zip : 48083-1905
Country : US
Telephone Number : 248-524-8801
Fax Number : 248-524-8875
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2009
Last Update Date : 01/28/2015

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Directions to “ SHANNON EMERSON ” Practice Location

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