Basic Information
| Provider Information | |||||||||
| NPI: | 1235420027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KYROLAINEN | ||||||||
| FirstName: | SHANDELLE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MECOMBER | ||||||||
| OtherFirstName: | SHANDELLE | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LMSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1085 S LINDEN RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107323240 | ||||||||
| FaxNumber: | 8102300280 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 S LINDEN RD | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485324073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107332011 | ||||||||
| FaxNumber: | 8107331872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2011 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801071422 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.