Provider Demographics
NPI:1871716787
Name:BRICE, SHANNON M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:M
Last Name:BRICE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-4405
Mailing Address - Country:US
Mailing Address - Phone:715-246-4840
Mailing Address - Fax:715-254-9459
Practice Address - Street 1:250 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-4405
Practice Address - Country:US
Practice Address - Phone:715-246-4840
Practice Address - Fax:715-254-9459
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7379-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI372794OtherMHN HMC INSURANCE
WI40938900Medicaid