Provider Demographics
NPI:1184377707
Name:ADKISSON, SHAWN DENISE
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:DENISE
Last Name:ADKISSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHAWN
Other - Middle Name:DENISE
Other - Last Name:ADKISSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 18704
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-0704
Mailing Address - Country:US
Mailing Address - Phone:414-467-3876
Mailing Address - Fax:
Practice Address - Street 1:5228 W FOND DU LAC AVE STE 18
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1346
Practice Address - Country:US
Practice Address - Phone:414-988-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty