Provider Demographics
NPI:1265551642
Name:SHAVER, CAROL ANN (EDD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:SHAVER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5722 ST JOSEPH AVENUE
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127
Mailing Address - Country:US
Mailing Address - Phone:269-429-4148
Mailing Address - Fax:269-429-6878
Practice Address - Street 1:5722 ST JOSEPH AVENUE
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127
Practice Address - Country:US
Practice Address - Phone:269-429-4148
Practice Address - Fax:269-429-6878
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006049103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist