Provider Demographics
NPI:1518295500
Name:STALOCH, SHANNON ANN (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:ANN
Last Name:STALOCH
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2479 LE CONTE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1236
Mailing Address - Country:US
Mailing Address - Phone:408-464-1441
Mailing Address - Fax:510-991-1562
Practice Address - Street 1:2479 LE CONTE AVE APT 3
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1236
Practice Address - Country:US
Practice Address - Phone:408-464-1441
Practice Address - Fax:510-991-1562
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM249176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife