Active NPI
Shannon Lee Waltz
- Social Worker
- Adrian, MI
National Provider Identifier
1740012756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6851115127
- Practice address
- 770 Riverside Ave Ste 14
Adrian, MI 49221-1465 - Phone
- (517) 438-8144
- NPI assigned
- Aug 19, 2024
- Last updated
- Aug 19, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6851115127 | MI | Primary |
Addresses
Primary practice location
770 Riverside Ave Ste 14
Adrian, MI 49221-1465
Mailing address
1859 Harold St
Adrian, MI 49221-4461
Phone (517) 759-9213
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6851115127 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724025600000",
"number": "1740012756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1859 HAROLD ST",
"city": "ADRIAN",
"state": "MI",
"postal_code": "492214461",
"telephone_number": "517-759-9213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "770 RIVERSIDE AVE STE 14",
"city": "ADRIAN",
"state": "MI",
"postal_code": "492211465",
"telephone_number": "517-438-8144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTZ",
"first_name": "SHANNON",
"middle_name": "LEE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-19",
"last_updated": "2024-08-19",
"certification_date": "2024-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6851115127",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Adrian, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.