Healthcare Provider Details

I. General information

NPI: 1992612667
Provider Name (Legal Business Name): JORIE SHANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5075 N SHERMAN BLVD
MILWAUKEE WI
53209-5246
US

IV. Provider business mailing address

410 W HAMPTON AVE APT 207
MILWAUKEE WI
53217-5409
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-4939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: