Provider Demographics
NPI:1730256082
Name:MARTTILA, SHANNON EILEEN (BS, CADCM, CCSM)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:EILEEN
Last Name:MARTTILA
Suffix:
Gender:F
Credentials:BS, CADCM, CCSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5832 OSTER DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-2648
Mailing Address - Country:US
Mailing Address - Phone:248-738-0319
Mailing Address - Fax:
Practice Address - Street 1:3139 W. HURON
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328
Practice Address - Country:US
Practice Address - Phone:248-738-8400
Practice Address - Fax:248-738-8404
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)