MEDICARE: SHANA GREENWICH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1295211951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA GREENWICH

Provider Business Mailing Address
First Line	:	400 W RIVER WOODS PKWY
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53212-1060
Country	:	US
Telephone Number	:	414-874-6288
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W RIVER WOODS PKWY
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53212-1060
Country	:	US
Telephone Number	:	414-874-6288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	09/12/2024

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Directions to “ SHANA GREENWICH ” Practice Location

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