Provider Demographics
NPI:1750813473
Name:KRAMER, SHAWN I
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:KRAMER
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 PLUMTREE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7433
Mailing Address - Country:US
Mailing Address - Phone:217-493-7086
Mailing Address - Fax:
Practice Address - Street 1:337 LEMKE ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-5926
Practice Address - Country:US
Practice Address - Phone:989-492-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician