Provider Demographics
NPI:1760252779
Name:SHANNON-HUTCHISON, NAT R (LCSW)
Entity Type:Individual
Prefix:
First Name:NAT
Middle Name:R
Last Name:SHANNON-HUTCHISON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6082 N GATEHOUSE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7014
Mailing Address - Country:US
Mailing Address - Phone:773-457-8502
Mailing Address - Fax:
Practice Address - Street 1:6082 N GATEHOUSE DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7014
Practice Address - Country:US
Practice Address - Phone:773-457-8502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0260071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical