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General NPI Number Information
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NPI Number | 1710418314
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Entity Type | Individual
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Provider Name | MRS. SHIRLEY WORTHAM
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Gender | Female
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | N3152 STATE ROAD 81
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City | MONROE
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State | WI
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Zip | 53566-9397
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Country | US
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Telephone | 608-328-9393
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Fax | 608-328-9480
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Provider Business Mailing Address
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Address Line | N3152 STATE ROAD 81
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City | MONROE
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State | WI
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Zip | 53566-9397
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Country | US
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Telephone | 608-328-9393
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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 | 281728
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2817-226
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License Number State | WI
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