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Individual

SHANNON BROEKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
1317 W GRAND AVE STE 6, PORT WASHINGTON, WI 53074-2075
(262) 427-8905
Mailing address
4800 N SCOTTSDALE RD STE 2500, SCOTTSDALE, AZ 85251-7630

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
11969-125
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11969
COUNSELOR
WI
01
7529
STATE OF WISONSIN
WI
Enumeration date
06/19/2024
Last updated
01/13/2026
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