Provider Demographics
NPI:1043785082
Name:NEIMEKO, SHANNON JUNIPER (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:JUNIPER
Last Name:NEIMEKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 CANTWELL CT # 1
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3708
Mailing Address - Country:US
Mailing Address - Phone:608-628-1550
Mailing Address - Fax:
Practice Address - Street 1:568 GRAND CANYON DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1033
Practice Address - Country:US
Practice Address - Phone:608-628-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5517-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional