Provider Demographics
NPI:1184463556
Name:SHAW, SADIE LYNETTE (LLMSW)
Entity type:Individual
Prefix:MS
First Name:SADIE
Middle Name:LYNETTE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 LIBERTY BELLE CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3023
Mailing Address - Country:US
Mailing Address - Phone:989-820-0494
Mailing Address - Fax:
Practice Address - Street 1:5980 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2377
Practice Address - Country:US
Practice Address - Phone:989-820-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511185181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical