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Individual
MR. SHANE SPEAKER
Active
Individual
MR. SHANE SPEAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
6801094324
MI
Other
Enumeration date
01/08/2019
Last updated
01/08/2019
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