Healthcare Provider Details

I. General information

NPI: 1487290078
Provider Name (Legal Business Name): SHAREESE TRIPLETT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 MONONA DR STE 200
MONONA WI
53716-3561
US

IV. Provider business mailing address

5900 MONONA DR STE 200
MONONA WI
53716-3561
US

V. Phone/Fax

Practice location:
  • Phone: 608-286-1132
  • Fax: 608-440-2954
Mailing address:
  • Phone: 608-286-1132
  • Fax: 608-440-2954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6683-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6683-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: