Individual
SHANI A YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LIFE COACH
Contact information
Practice address
5104 N 20TH ST, MILWAUKEE, WI 53209-5717
(414) 630-1169
Mailing address
5104 N 20TH ST, MILWAUKEE, WI 53209-5717
(414) 630-1169
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20467-130
WI
101YP2500X
Professional Counselor
—
—
171400000X
Health & Wellness Coach
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101YA0400X
WI STATE DSPS
WI
01
—
171400000X
EDUCATIONAL COURSE
—
Enumeration date
07/17/2022
Last updated
01/30/2024
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