Provider Demographics
NPI:1891118170
Name:SHIMKUSPEAKING, PLLC
Entity Type:Organization
Organization Name:SHIMKUSPEAKING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SHIMKUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC
Authorized Official - Phone:248-884-2701
Mailing Address - Street 1:411 N CASTELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1822
Mailing Address - Country:US
Mailing Address - Phone:248-884-2701
Mailing Address - Fax:248-759-4110
Practice Address - Street 1:47100 SCHOENHERR RD
Practice Address - Street 2:SUITE B
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4716
Practice Address - Country:US
Practice Address - Phone:248-884-2701
Practice Address - Fax:248-759-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801018089251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid
MIF37164072OtherMEDICARE PTAN