Provider Demographics
NPI:1487842373
Name:UFKES, SHANNON (MA, LLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:UFKES
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-0466
Mailing Address - Country:US
Mailing Address - Phone:269-789-8866
Mailing Address - Fax:517-924-1816
Practice Address - Street 1:694 W CHICAGO RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-8405
Practice Address - Country:US
Practice Address - Phone:517-279-8866
Practice Address - Fax:517-924-1816
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010206103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist