Individual
SHAWNA M TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 327-8133
(616) 327-6904
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301019355
MI
103TC0700X
Clinical Psychologist
PSY50000290
MA
Other
Enumeration date
04/02/2020
Last updated
03/04/2026
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