Provider Demographics
NPI:1982242004
Name:GAFFNEY, SHARON M (LPC-IT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:GAFFNEY
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CAPITOL DR # 103
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-5706
Mailing Address - Country:US
Mailing Address - Phone:262-309-1417
Mailing Address - Fax:
Practice Address - Street 1:1300 CAPITOL DR # 103
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-5706
Practice Address - Country:US
Practice Address - Phone:262-309-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4547-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health