Provider Demographics
NPI:1487388971
Name:ROSSMAN, SHANNON MARIE (LBSW, CADC, CPRC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:ROSSMAN
Suffix:
Gender:F
Credentials:LBSW, CADC, CPRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 EMMET ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2910
Mailing Address - Country:US
Mailing Address - Phone:231-330-0593
Mailing Address - Fax:313-475-4222
Practice Address - Street 1:704 EMMET ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2910
Practice Address - Country:US
Practice Address - Phone:231-347-5511
Practice Address - Fax:231-347-5422
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852091301104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker