Healthcare Provider Details

I. General information

NPI: 1902717572
Provider Name (Legal Business Name): SHELBY BORCHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W7327 ANDERSON AVE
SHAWANO WI
54166-1143
US

IV. Provider business mailing address

W7327 ANDERSON AVE
SHAWANO WI
54166-1143
US

V. Phone/Fax

Practice location:
  • Phone: 715-526-4700
  • Fax: 715-526-5542
Mailing address:
  • Phone: 715-526-4700
  • Fax: 715-526-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13132
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: