Provider Demographics
NPI:1679890347
Name:SHEA, LINDA L (CSAC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:SHEA
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6508
Mailing Address - Fax:608-741-6918
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2940
Practice Address - Country:US
Practice Address - Phone:608-756-6508
Practice Address - Fax:608-741-6918
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15480-132101YA0400X
WI15450131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679890347Medicaid