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General NPI Number Information
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NPI Number | 1508675968
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Entity Type | Individual
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Provider Name | WILLIAM ALBERT SHOPE
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Gender | Male
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 9198A THRALL RD
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City | WOODRUFF
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State | WI
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Zip | 54568-9329
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Country | US
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Telephone | 715-439-4377
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Fax |
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Provider Business Mailing Address
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Address Line | 12308 E FITZGERALD LN
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City | MANITOWISH WATERS
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State | WI
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Zip | 54545-9249
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Country | US
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Telephone | 715-904-0869
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20740130
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License Number State | WI
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