Individual
MISS SUSAN SHOPODOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CLINICAL SOCIAL WORK
Contact information
Practice address
816 WASHINGTON ST, MANITOWOC, WI 54220-4537
(920) 645-3743
Mailing address
816 WASHINGTON ST, MANITOWOC, WI 54220-4537
(920) 652-6065
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
19773
WI
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
11553-123
—
1041C0700X
Clinical Social Worker
Primary
11553-123
WI
Other
Enumeration date
01/16/2023
Last updated
07/24/2024
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