Provider Demographics
NPI:1043358708
Name:SHOOK-WOOLLEY, DARCI (PSYD)
Entity type:Individual
Prefix:DR
First Name:DARCI
Middle Name:
Last Name:SHOOK-WOOLLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W175N11163 STONEWOOD DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6500
Mailing Address - Country:US
Mailing Address - Phone:262-257-0500
Mailing Address - Fax:262-257-0602
Practice Address - Street 1:W175N11163 STONEWOOD DR
Practice Address - Street 2:SUITE 221
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6503
Practice Address - Country:US
Practice Address - Phone:262-257-0500
Practice Address - Fax:262-257-0602
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2451-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43568200Medicaid
WI000144815Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID