Provider Demographics
NPI:1205058344
Name:SHOCK, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:SHOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:SHOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2000 HOGBACK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9735
Mailing Address - Country:US
Mailing Address - Phone:734-386-0041
Mailing Address - Fax:
Practice Address - Street 1:2000 HOGBACK RD STE 2
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9735
Practice Address - Country:US
Practice Address - Phone:736-386-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)