1174634703 NPI number — SHANNON R LAVOIE-THOMPSON LMSW

Table of content: SHANNON R LAVOIE-THOMPSON LMSW (NPI 1174634703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174634703 NPI number — SHANNON R LAVOIE-THOMPSON LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAVOIE-THOMPSON
Provider First Name:
SHANNON
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVELEIGH
Provider Other First Name:
SHANNON
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174634703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
323 N STATE ST
Provider Second Line Business Mailing Address:
PO BOX 239
Provider Business Mailing Address City Name:
CARO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48723-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-673-6191
Provider Business Mailing Address Fax Number:
989-673-1596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1332 PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48723-9288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-673-6191
Provider Business Practice Location Address Fax Number:
989-672-3443
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6802081338 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com