Healthcare Provider Details

I. General information

NPI: 1417173477
Provider Name (Legal Business Name): SHEILA A SAMPTON MSW, CAPSW, ICS,CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6318 W NORTH AVE UPPR
WAUWATOSA WI
53213-2013
US

IV. Provider business mailing address

1730 W NORTH AVENUE COUNSELING AND WELLNESS CLINIC
MILWAUKEE WI
53205-1254
US

V. Phone/Fax

Practice location:
  • Phone: 414-526-0499
  • Fax: 414-963-2691
Mailing address:
  • Phone: 414-906-2700
  • Fax: 414-963-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1086-132
License Number StateWI
# 7
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1718-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: