Individual
SHANNON L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
6815 W CAPITOL DR, MILWAUKEE, WI 53216-2070
(414) 466-3204
Mailing address
6815 W CAPITOL DR, MILWAUKEE, WI 53216-2070
(414) 466-3204
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40946500
—
WI
Enumeration date
01/27/2009
Last updated
01/27/2009
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