Provider Demographics
NPI:1144105958
Name:STEVENS, SHANNON (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1343 MORTENSEN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:WI
Mailing Address - Zip Code:53521-8925
Mailing Address - Country:US
Mailing Address - Phone:608-692-1663
Mailing Address - Fax:
Practice Address - Street 1:W1343 MORTENSEN RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:WI
Practice Address - Zip Code:53521-8925
Practice Address - Country:US
Practice Address - Phone:608-692-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
WI12379-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool