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Organization
SHAWN L. GAUTHIER
Active
Organization
SHAWN L. GAUTHIER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN L. GAUTHIER LMSW (CLINICAL SOCIAL WORKER)
(616) 308-6423
Entity
Organization
Contact information
Practice address
771 KENMOOR AVE SE, GRAND RAPIDS, MI 49546-2370
(616) 301-3479
(616) 301-3508
Mailing address
1629 BLUE GRASS CT SE, GRAND RAPIDS, MI 49546-6217
(616) 308-6423
(616) 301-3508
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801080903
MI
Other
Enumeration date
12/30/2009
Last updated
12/30/2009
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