Provider Demographics
NPI:1235869322
Name:NORTHERN, SHIRLENE MARIE
Entity Type:Individual
Prefix:
First Name:SHIRLENE
Middle Name:MARIE
Last Name:NORTHERN
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 1:7525 KALAMAZOO DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7413
Mailing Address - Country:US
Mailing Address - Phone:916-604-1349
Mailing Address - Fax:
Practice Address - Street 1:7525 KALAMAZOO DR
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7413
Practice Address - Country:US
Practice Address - Phone:916-604-1349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst