Provider Demographics
NPI:1073047619
Name:GRAMS, SHAUNIE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAUNIE
Middle Name:ELIZABETH
Last Name:GRAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAUNIE
Other - Middle Name:ELIZABETH
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 PIER CT
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-5827
Mailing Address - Country:US
Mailing Address - Phone:224-632-0117
Mailing Address - Fax:
Practice Address - Street 1:15 PIER CT
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-5827
Practice Address - Country:US
Practice Address - Phone:224-632-0117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9617104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker