Provider Demographics
NPI:1609527357
Name:LANGLOIS-KONDRACKI, SHANNON DAWN (LMSW, CAADC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:DAWN
Last Name:LANGLOIS-KONDRACKI
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ANN ST NW STE 207
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2054
Mailing Address - Country:US
Mailing Address - Phone:616-965-1229
Mailing Address - Fax:
Practice Address - Street 1:400 ANN ST NW STE 207
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-2054
Practice Address - Country:US
Practice Address - Phone:616-965-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011211421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical