Provider Demographics
NPI:1710101258
Name:SHEGAN, MARY KATHERINE (LMSW ACSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHERINE
Last Name:SHEGAN
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8244 S AGATE RD
Mailing Address - Street 2:
Mailing Address - City:TROUT CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49967
Mailing Address - Country:US
Mailing Address - Phone:906-852-3485
Mailing Address - Fax:
Practice Address - Street 1:13958 US HWY 45
Practice Address - Street 2:WAKEFIELD
Practice Address - City:BRUCE CROSSING
Practice Address - State:MI
Practice Address - Zip Code:49912-0128
Practice Address - Country:US
Practice Address - Phone:906-852-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010121511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P26400Medicare ID - Type Unspecified