Individual
KIRYL N SHADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
12500 AURORA DR, PLEASANT PRAIRIE, WI 53158-1227
(262) 857-5000
(262) 857-5001
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
22780
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100209168
—
WI
Enumeration date
08/26/2015
Last updated
07/30/2025
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