Provider Demographics
NPI:1619398005
Name:BABCOCK, SHELLIE K (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:K
Last Name:BABCOCK
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 1:6121 GREEN BAY RD STE 240
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2929
Mailing Address - Country:US
Mailing Address - Phone:262-564-5305
Mailing Address - Fax:262-564-5306
Practice Address - Street 1:6121 GREEN BAY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2926
Practice Address - Country:US
Practice Address - Phone:262-652-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7968-123251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health