Active NPI
Nancy Shea, LCSW
- Clinical Social Worker
- Lake Mills, WI
National Provider Identifier
1265420491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1697
- Practice address
- 200 E Tyranena Park Rd
Lake Mills, WI 53551-9678 - Phone
- (920) 648-8393
- NPI assigned
- Oct 11, 2005
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1697 | WI | Primary |
Addresses
Primary practice location
200 E Tyranena Park Rd
Lake Mills, WI 53551-9678
Mailing address
611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Phone (920) 568-6558
Other practice location 1
704 Katie Ct
Cambridge, WI 53523-9308
Phone (608) 423-1100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39634600 | Medicaid | WI | |
| 1011361 | Other | WI | PHYSICIANS PLUS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nshea709800@direct.uwhealth.org |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1697 | WI | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620086400000",
"number": "1265420491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 SHERMAN AVE E",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "535381960",
"telephone_number": "920-568-6558",
"fax_number": "920-568-4004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E TYRANENA PARK RD",
"city": "LAKE MILLS",
"state": "WI",
"postal_code": "535519678",
"telephone_number": "920-648-8393"
}
],
"practiceLocations": [
{
"address_1": "704 Katie Ct",
"address_purpose": "LOCATION",
"city": "Cambridge",
"state": "WI",
"postal_code": "535239308",
"country_code": "US",
"telephone_number": "608-423-1100",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHEA",
"first_name": "NANCY",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-11",
"last_updated": "2021-05-04",
"certification_date": "2021-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "1697",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39634600",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIANS PLUS",
"identifier": "1011361",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "nshea709800@direct.uwhealth.org",
"affiliation": "N",
"address_1": "200 E Tyranena Park Rd",
"city": "Lake Mills",
"state": "WI",
"country_code": "US",
"postal_code": "535519678",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lake Mills, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.