MEDICARE: SHELBY HAUSMAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	10994-125	WI
2	101YP2500X	Professional Counselor		WI

General Provider Information

NPI Number	:	1194421610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY HAUSMAN LPC

Provider Business Mailing Address
First Line	:	14755 W CAPITOL DR STE 100
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-2318
Country	:	US
Telephone Number	:	414-292-4242
Fax Number	:	414-292-4182

Provider Business Practice Location Address
First Line	:	14755 W CAPITOL DR STE 100
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-2318
Country	:	US
Telephone Number	:	414-292-4242
Fax Number	:	414-292-4182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	08/08/2024

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Directions to “ SHELBY HAUSMAN LPC” Practice Location

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