Healthcare Provider Details

I. General information

NPI: 1114822152
Provider Name (Legal Business Name): SHANNON PATTERSON PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1882 E MAIN ST STE 202
MADISON WI
53704-5288
US

IV. Provider business mailing address

1882 E MAIN ST STE 202
MADISON WI
53704-5288
US

V. Phone/Fax

Practice location:
  • Phone: 608-515-8673
  • Fax: 353-200-9796
Mailing address:
  • Phone: 608-515-8673
  • Fax: 353-200-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SHANNON LYNN PATTERSON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 608-495-0814