Active NPI
Shannon Michelle Kelly, MSW
- Social Worker
- Beaver Dam, WI
National Provider Identifier
1043957095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- MSW
- Practice address
- 650 S Center St
Beaver Dam, WI 53916-2804 - Phone
- (920) 212-7820
- Fax
- (608) 720-1719
- NPI assigned
- May 19, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | MSW | WI | Primary |
Addresses
Primary practice location
650 S Center St
Beaver Dam, WI 53916-2804
Mailing address
650 S Center St
Beaver Dam, WI 53916-2804
Phone (920) 212-7820
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MSW | WI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652918400000",
"number": "1043957095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 S CENTER ST",
"city": "BEAVER DAM",
"state": "WI",
"postal_code": "539162804",
"telephone_number": "920-212-7820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 S CENTER ST",
"city": "BEAVER DAM",
"state": "WI",
"postal_code": "539162804",
"telephone_number": "920-212-7820",
"fax_number": "608-720-1719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "SHANNON",
"middle_name": "MICHELLE",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-19",
"last_updated": "2022-05-19",
"certification_date": "2022-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "MSW",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaver Dam, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.