| NPI | 1184273252 |
|---|---|
| Former Name | STEPHANIE NICOLE SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801105356) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 68011105356) |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2024-05-05 |