Provider Demographics
NPI:1023154838
Name:SHIMKUS, ANNETTE M (MSW, ACSW, LMSW)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:SHIMKUS
Suffix:
Gender:F
Credentials:MSW, ACSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010180891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid
MI1883825Medicaid