Provider Demographics
NPI:1164089066
Name:RICHARDSON, SHAWN KRISTEN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:KRISTEN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9639
Mailing Address - Country:US
Mailing Address - Phone:989-277-0658
Mailing Address - Fax:
Practice Address - Street 1:15700 W 10 MILE RD STE 106
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2100
Practice Address - Country:US
Practice Address - Phone:989-225-4111
Practice Address - Fax:248-575-4555
Is Sole Proprietor?:No
Enumeration Date:2019-05-26
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010812351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical