Provider Demographics
NPI:1821723412
Name:NORTHROP, SHAWN WILLIAM (LMSW)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:WILLIAM
Last Name:NORTHROP
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2541 DEER PATH DR
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-9517
Mailing Address - Country:US
Mailing Address - Phone:805-302-9615
Mailing Address - Fax:
Practice Address - Street 1:700 OWENA ST
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1953
Practice Address - Country:US
Practice Address - Phone:715-504-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851115100104100000X
WI132745-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker