Provider Demographics
NPI:1124228655
Name:BRUBAKER, SHAVONNE ANNETTE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHAVONNE
Middle Name:ANNETTE
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:655 E CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-2215
Mailing Address - Country:US
Mailing Address - Phone:989-426-9295
Mailing Address - Fax:989-426-2251
Practice Address - Street 1:301 S CRAPO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-772-5938
Practice Address - Fax:989-775-7701
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010893311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical