Individual
MS. SHELLY WISSINK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
429 GAMMON PL STE 200, MADISON, WI 53719-1053
(608) 772-9582
Mailing address
429 GAMMON PL STE 200, MADISON, WI 53719-1053
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6856-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
NONE
WI
Enumeration date
08/15/2018
Last updated
04/18/2020
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