Healthcare Provider Details

I. General information

NPI: 1144160508
Provider Name (Legal Business Name): SHANNON ZAJKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E LONGVIEW DR
APPLETON WI
54911-2149
US

IV. Provider business mailing address

620 E LONGVIEW DR
APPLETON WI
54911-2149
US

V. Phone/Fax

Practice location:
  • Phone: 920-238-3340
  • Fax:
Mailing address:
  • Phone: 920-238-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5032-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: