Individual
LISA SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1345 W MASON ST STE 102, GREEN BAY, WI 54303-2049
(920) 301-3546
(920) 301-3400
Mailing address
1345 W MASON ST STE 102, GREEN BAY, WI 54303-2049
(920) 301-3546
(920) 301-3400
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7747-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43086600
—
WI
Enumeration date
09/20/2006
Last updated
11/23/2022
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