Provider Demographics
NPI:1467719211
Name:SHAW, KRISTIN M (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:SHAW
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 1:228 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-1919
Mailing Address - Country:US
Mailing Address - Phone:920-217-7612
Mailing Address - Fax:920-455-0925
Practice Address - Street 1:414 E WALNUT ST STE 210
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-5020
Practice Address - Country:US
Practice Address - Phone:920-455-0925
Practice Address - Fax:920-455-0925
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health