Individual provider · NPI-1

Shannon Kelley

Day Training/Habilitation Specialist · Detroit, MI

NPI number1639537913
StatusActive
Last updated in NPPESFeb 13, 2025

Details

NPI
1639537913
Entity type
Individual (NPI-1)
Name
Shannon Kelley
Sex
Female
Sole proprietor
Yes
Enumeration date
Feb 2, 2016
Certification date
Feb 13, 2025
Last updated
Feb 13, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
373H00000X Day Training/Habilitation Specialist––Yes
251B00000X Case Management––

Practice location

3111 Grand River Ave
Detroit, MI 48208-2962

Phone 313-557-8669

Mailing address

3111 Grand River Ave
Detroit, MI 48208-2962

Phone 313-557-8669

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