Individual
REGINA DONNETTE SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1720 W FLORIST AVE STE 125, GLENDALE, WI 53209-3862
(414) 247-0801
(414) 247-0816
Mailing address
1720 W FLORIST AVE STE 125, GLENDALE, WI 53209-3862
(414) 247-0801
(141) 247-0816
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4981
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4981
LICENSE
WI
Enumeration date
07/08/2021
Last updated
07/08/2021
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