Organization
MODERN WELLNESS LLC
Active
Organization
MODERN WELLNESS LLC
Active
Other names
Modern Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA SHAW LPC (LPC)
(262) 221-0369
Entity
Organization
Contact information
Practice address
W180S8264 PIONEER DR, MUSKEGO, WI 53150-9457
(262) 221-0369
Mailing address
W180S8264 PIONEER DR, MUSKEGO, WI 53150-9457
(262) 221-0369
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/29/2024
Last updated
01/28/2026
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