Individual
JENNIFER ANN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
9453 KOCHVILLE RD, FREELAND, MI 48623-8623
(989) 878-0630
Mailing address
PO BOX 141, FREELAND, MI 48623-0141
(989) 878-0630
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101004279
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
834620596
BCBS
MI
01
—
834620596
UNITED HEALTHCARE
—
05
—
834620596
—
MI
Enumeration date
06/29/2019
Last updated
06/29/2019
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