Provider Demographics
NPI:1841577889
Name:SHANK, JENNIFER KRISITINE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KRISITINE
Last Name:SHANK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 N JEBAVY DR
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2910
Mailing Address - Country:US
Mailing Address - Phone:231-613-2401
Mailing Address - Fax:231-425-4036
Practice Address - Street 1:239 N JEBAVY DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2910
Practice Address - Country:US
Practice Address - Phone:231-613-2401
Practice Address - Fax:231-425-4036
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010895761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical