Provider Demographics
NPI:1467856179
Name:OLIVER, SHANNON LYNN (BS, LBSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LYNN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:BS, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25099 PAMELA ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4523
Mailing Address - Country:US
Mailing Address - Phone:734-250-2546
Mailing Address - Fax:313-871-1807
Practice Address - Street 1:100 RIVER PLACE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4274
Practice Address - Country:US
Practice Address - Phone:313-871-2337
Practice Address - Fax:313-871-1805
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085005104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker