Individual provider Active NPI

Shannon Marie Conover

  • Clinical Social Worker
  • Port Huron, MI
National Provider Identifier
1376052845
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
3111 Electric Ave
Port Huron, MI 48060-8127
Phone
(810) 966-3520
NPI assigned
Sep 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

3111 Electric Ave
Port Huron, MI 48060-8127

Mailing address

3111 Electric Ave
Port Huron, MI 48060-8127
Phone (810) 966-3520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241012000321 MI Practitioner - Clinical Social Worker 8022540210 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St Clair County Community Mental Health Authority CurrentSince Jul 25, 2024 Accepting new patients
St Clair County Community Mental Health Authority CurrentSince Jul 25, 2024 Accepting new patients
Richard Kneip, PH.D., P.C. Past Accepting new patients

Locations

135 Broadway St
Marine City, MI 48039
Phone (810) 400-4200

3111 Electric Ave
Port Huron, MI 48060
Phone (810) 985-4747

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1376052845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608127",
            "telephone_number": "810-966-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608127",
            "telephone_number": "810-966-3520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONOVER",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.