Provider Demographics
NPI:1053900092
Name:BORTON, SHANNON JEAN (FSA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:JEAN
Last Name:BORTON
Suffix:
Gender:
Credentials:FSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-9702
Mailing Address - Country:US
Mailing Address - Phone:989-831-7520
Mailing Address - Fax:989-831-7578
Practice Address - Street 1:611 N STATE ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9702
Practice Address - Country:US
Practice Address - Phone:989-831-7520
Practice Address - Fax:989-831-7578
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health