Provider Demographics
NPI:1619392081
Name:BOOMS, SHAUNA MARIE
Entity type:Individual
Prefix:MISS
First Name:SHAUNA
Middle Name:MARIE
Last Name:BOOMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 S RUTH RD
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-8135
Mailing Address - Country:US
Mailing Address - Phone:989-315-1750
Mailing Address - Fax:
Practice Address - Street 1:1263 SAND BEACH RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-8817
Practice Address - Country:US
Practice Address - Phone:989-269-9229
Practice Address - Fax:989-269-2587
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes172V00000XOther Service ProvidersCommunity Health Worker