Provider Demographics
NPI:1275074262
Name:SHOTWELL, GARRETT (LCSW)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:SHOTWELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 ABBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4107
Mailing Address - Country:US
Mailing Address - Phone:773-318-7304
Mailing Address - Fax:
Practice Address - Street 1:342 S ASHLEY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1351
Practice Address - Country:US
Practice Address - Phone:773-318-7304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC 607085021041C0700X
IL1490202991041C0700X
MI68011161101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical