Provider Demographics
NPI:1851643332
Name:BARTLETT, SHANNON ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 HIGHLAND VW
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:WI
Mailing Address - Zip Code:54082-2408
Mailing Address - Country:US
Mailing Address - Phone:715-954-4585
Mailing Address - Fax:
Practice Address - Street 1:2910 ENLOE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-4538
Practice Address - Country:US
Practice Address - Phone:715-377-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4899-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional