Provider Demographics
NPI:1972616795
Name:SCHAEFER, SHANNON C (PHD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:C
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2620 STEWART AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4170
Mailing Address - Country:US
Mailing Address - Phone:715-842-9500
Mailing Address - Fax:715-848-0425
Practice Address - Street 1:2620 STEWART AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4170
Practice Address - Country:US
Practice Address - Phone:715-842-9500
Practice Address - Fax:715-848-0425
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2632-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical