Provider Demographics
NPI:1326914938
Name:MCELROY, SHANNAN L
Entity type:Individual
Prefix:
First Name:SHANNAN
Middle Name:L
Last Name:MCELROY
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 1:4455 N 89TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-5020
Mailing Address - Country:US
Mailing Address - Phone:414-350-1269
Mailing Address - Fax:414-350-1269
Practice Address - Street 1:4455 N 89TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-5020
Practice Address - Country:US
Practice Address - Phone:414-350-1269
Practice Address - Fax:414-350-1269
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator