Provider Demographics
NPI:1689491813
Name:SHAWL THERAPY AND CONSULTING, LLC
Entity type:Organization
Organization Name:SHAWL THERAPY AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAWL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-218-4493
Mailing Address - Street 1:680 FAIRVIEW TER
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1506
Mailing Address - Country:US
Mailing Address - Phone:608-218-4493
Mailing Address - Fax:
Practice Address - Street 1:2923 MARKETPLACE DR STE 204
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5321
Practice Address - Country:US
Practice Address - Phone:608-549-5781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1619586393Medicaid