Provider Demographics
NPI:1508282641
Name:BROWN, SHANNON JENNIE ELAINE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:JENNIE ELAINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 MOHAWK CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3828
Mailing Address - Country:US
Mailing Address - Phone:734-883-3721
Mailing Address - Fax:
Practice Address - Street 1:888 WEST BIG BEAVER
Practice Address - Street 2:SUITE 1450
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-244-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010849371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical