Provider Demographics
NPI:1578765053
Name:SHUMAKER, VICKI LYNN (MA, LMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:SHUMAKER
Suffix:
Gender:F
Credentials:MA, LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 MEADOW RUN DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-9054
Mailing Address - Country:US
Mailing Address - Phone:269-945-8806
Mailing Address - Fax:269-945-8831
Practice Address - Street 1:450 MEADOW RUN DR STE 400
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-9054
Practice Address - Country:US
Practice Address - Phone:269-945-8806
Practice Address - Fax:269-945-8831
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010892261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA39524007Medicare PIN