Provider Demographics
NPI:1912061359
Name:OLSHOVE, SHANNON KRISTI (MS, LLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KRISTI
Last Name:OLSHOVE
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2119
Mailing Address - Country:US
Mailing Address - Phone:231-947-7348
Mailing Address - Fax:
Practice Address - Street 1:3180 RACQUET CLUB DR
Practice Address - Street 2:SUITE G
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4797
Practice Address - Country:US
Practice Address - Phone:231-922-2885
Practice Address - Fax:231-922-0135
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010639103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical