Individual
SHANNON HURLBUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
320 S. WALNUT ST., APPLETON, WI 54911-5918
(920) 832-5270
(920) 832-4767
Mailing address
320 S. WALNUT ST., APPLETON, WI 54911-5918
(920) 832-5270
(920) 832-4767
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
127443
WI
1041C0700X
Clinical Social Worker
Primary
11131-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100160659
—
WI
Enumeration date
07/30/2019
Last updated
03/15/2023
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