Provider Demographics
NPI:1013766153
Name:STAMANN, SHELBY MARIE (RBT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE
Last Name:STAMANN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:MARIE
Other - Last Name:STAMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4706 SUNDIAL DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9449
Mailing Address - Country:US
Mailing Address - Phone:616-293-1044
Mailing Address - Fax:
Practice Address - Street 1:1545 68TH ST SE STE 201
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-7896
Practice Address - Country:US
Practice Address - Phone:231-668-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician