Healthcare Provider Details

I. General information

NPI: 1528952959
Provider Name (Legal Business Name): SHANA LOUISE ELISE WILLENBRING LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANA LOUISE BISCHOF LMSW

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N FRANKLIN ST UNIT 9
MANCHESTER IA
52057-1541
US

IV. Provider business mailing address

100 N FRANKLIN ST UNIT 9
MANCHESTER IA
52057-1541
US

V. Phone/Fax

Practice location:
  • Phone: 319-435-1819
  • Fax:
Mailing address:
  • Phone: 319-435-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number06049
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number361651
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: