Provider Demographics
NPI:1326406414
Name:SHAMPO, KAYLIN ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAYLIN
Middle Name:ANN
Last Name:SHAMPO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8028
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53708-8028
Mailing Address - Country:US
Mailing Address - Phone:608-242-8335
Mailing Address - Fax:
Practice Address - Street 1:1414 MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1318
Practice Address - Country:US
Practice Address - Phone:608-242-8335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health