Provider Demographics
NPI:1013804426
Name:SHANAVER, CHARLOTTE MARIA (PHD; LP; HSP)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:MARIA
Last Name:SHANAVER
Suffix:
Gender:F
Credentials:PHD; LP; HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24320 64TH PL
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9668
Mailing Address - Country:US
Mailing Address - Phone:262-758-1438
Mailing Address - Fax:
Practice Address - Street 1:3365 S 103RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4161
Practice Address - Country:US
Practice Address - Phone:414-604-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5246-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist