Provider Demographics
NPI:1083493738
Name:SHAW, MORGAN NICHOLE
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:NICHOLE
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 E COLE RD
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:MI
Mailing Address - Zip Code:48414-9303
Mailing Address - Country:US
Mailing Address - Phone:517-375-5911
Mailing Address - Fax:517-375-5911
Practice Address - Street 1:3471 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8552
Practice Address - Country:US
Practice Address - Phone:517-295-4672
Practice Address - Fax:517-295-4672
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician