Provider Demographics
NPI:1679838908
Name:HOPGOOD, SHANNON LEAH (CSAC, LPC-IT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEAH
Last Name:HOPGOOD
Suffix:
Gender:F
Credentials:CSAC, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2625 N. WEIL STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212
Mailing Address - Country:US
Mailing Address - Phone:414-962-1200
Mailing Address - Fax:414-962-2305
Practice Address - Street 1:2625 N. WEIL STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212
Practice Address - Country:US
Practice Address - Phone:414-962-1200
Practice Address - Fax:414-962-2305
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15575-132101YA0400X
WI212-226101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)