Provider Demographics
NPI:1417530122
Name:STORY, SHAWN RENA
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:RENA
Last Name:STORY
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 1:15560 JOY RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-8200
Mailing Address - Country:US
Mailing Address - Phone:313-668-9300
Mailing Address - Fax:248-994-8005
Practice Address - Street 1:15560 JOY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-8200
Practice Address - Country:US
Practice Address - Phone:313-668-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker