Provider Demographics
NPI:1346358447
Name:PFLUGARDT, SHAWN ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ANN
Last Name:PFLUGARDT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 KABEL AVE
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3918
Mailing Address - Country:US
Mailing Address - Phone:715-361-2805
Mailing Address - Fax:
Practice Address - Street 1:1020 KABEL AVE
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3918
Practice Address - Country:US
Practice Address - Phone:715-361-2805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2128-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44740Medicare ID - Type Unspecified