Healthcare Provider Details

I. General information

NPI: 1861082141
Provider Name (Legal Business Name): ERIN A SHANNON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E WISCONSIN AVE STE 1500
MILWAUKEE WI
53202-4808
US

IV. Provider business mailing address

2472 S BURRELL ST
MILWAUKEE WI
53207-1522
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax:
Mailing address:
  • Phone: 414-292-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12663-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: