Provider Demographics
NPI:1811554579
Name:SCHUMAKER, SHANNON RENEE (R1260670817)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE
Last Name:SCHUMAKER
Suffix:
Gender:F
Credentials:R1260670817
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11227 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3225
Mailing Address - Country:US
Mailing Address - Phone:626-444-0705
Mailing Address - Fax:
Practice Address - Street 1:11227 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3225
Practice Address - Country:US
Practice Address - Phone:626-444-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1260670817101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)