| Shannon James Llc | |
|
9730 W Bluemound Rd Ste 11 Wauwatosa WI 53226-4455 | |
| (414) 336-0525 | |
| (414) 930-2986 |
| Full Name | Shannon James Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9730 W Bluemound Rd Ste 11, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Shannon James (OWNER) |
| Authorized Official Contact | 4143360525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon James Llc 918 E North Ave Milwaukee WI 53212-3448 Ph: (414) 336-0525 | Shannon James Llc 9730 W Bluemound Rd Ste 11 Wauwatosa WI 53226-4455 Ph: (414) 336-0525 |
| NPI Number | 1982212551 |
|---|---|
| Provider Enumeration Date | 07/20/2020 |
| Last Update Date | 07/20/2020 |
| Certification Date | 07/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982212551 | NPI | - | NPPES |
| 10004541 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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