Provider Demographics
NPI:1821460429
Name:CLOUGH, SHAWNA
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6133
Mailing Address - Country:US
Mailing Address - Phone:715-246-4840
Mailing Address - Fax:
Practice Address - Street 1:1120 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6133
Practice Address - Country:US
Practice Address - Phone:715-246-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1381-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist