| Doctor Name: | JENNA SHAW |
| NPI Number: | 1174991830 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 7484 W Michigan Ave Suite C Pigeon, MI - 487555200 |
| Business Phone Number: | 9894533051 |
| Business Fax Number: | 9894533052 |
| Mailing Address: | 443 N State St, CARO |
| State: | MI |
| Postal Code: | 487231539 |
| Phone Number: | 9896726160 |
| Fax Number: | 9896725649 |
| NPI Enumeration Date: | 09/10/2015 |
| NPI Last Update Date: | 09/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |