Provider Demographics
NPI:1497489199
Name:SERF, SHAWN MARIA LYNN
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARIA LYNN
Last Name:SERF
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 1:3217 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-5230
Mailing Address - Country:US
Mailing Address - Phone:765-808-2055
Mailing Address - Fax:
Practice Address - Street 1:3640 N BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-6375
Practice Address - Country:US
Practice Address - Phone:463-214-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician