Individual
GRACE SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6070 NEWPORT RD, PORTAGE, MI 49002-9234
(269) 409-3000
Mailing address
4337 SUFFIELD WOODS AVE, PORTAGE, MI 49002-5884
(269) 303-4803
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6851119519
MI
Other
Enumeration date
02/13/2025
Last updated
02/26/2025
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