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General NPI Number Information
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NPI Number | 1447042379
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Entity Type | Individual
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Provider Name | SHANNON JOHN COLWIN MA
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Gender | Male
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 2909 LANDMARK PL STE 210
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City | MADISON
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State | WI
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Zip | 53713-4200
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Country | US
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Telephone | 855-458-4966
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Fax | 855-458-4966
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Provider Business Mailing Address
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Address Line | 2590 GLADEVIEW RD
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City | COTTAGE GROVE
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State | WI
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Zip | 53527-9531
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Country | US
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Telephone | 920-251-3333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8390226
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License Number State | WI
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