| Shannon Connell, Ph.d., Llc | |
|
36 W 8th St Ste 200 Holland MI 49423-2702 | |
| (616) 396-4846 | |
| (616) 396-4846 |
| Full Name | Shannon Connell, Ph.d., Llc |
|---|---|
| Speciality | Psychologist |
| Location | 36 W 8th St Ste 200, Holland, Michigan |
| Authorized Official Name and Position | Shannon Connell (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 6163964846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon Connell, Ph.d., Llc 36 W 8th St Ste 200 Holland MI 49423-2702 Ph: (616) 396-4846 | Shannon Connell, Ph.d., Llc 36 W 8th St Ste 200 Holland MI 49423-2702 Ph: (616) 396-4846 |
| NPI Number | 1457020877 |
|---|---|
| Provider Enumeration Date | 09/09/2021 |
| Last Update Date | 09/09/2021 |
| Certification Date | 09/09/2021 |
| Medicare PECOS PAC ID | 9931506037 |
|---|---|
| Medicare Enrollment ID | O20210915003810 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457020877 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shannon Connell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366685141 PECOS PAC ID: 0547667537 Enrollment ID: I20210917000304 |
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