Shannon Broderick, LSCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

07235 Issued in KS

Practice address

801 E Douglas Ave FL 2
Wichita, KS 67202-3548

Phone

(646) 941-7645

Fax

(929) 596-7897

NPI assigned

Jul 9, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Shannon Fleetwood Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781568000000",
    "number": "1386096790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 E DOUGLAS AVE FL 2",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023548",
            "telephone_number": "646-941-7645",
            "fax_number": "929-596-7897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E DOUGLAS AVE FL 2",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023548",
            "telephone_number": "646-941-7645",
            "fax_number": "929-596-7897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "SHANNON",
        "credential": "LSCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-09",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "KS",
            "license": "10002",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2016027520",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "07235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "FLEETWOOD",
            "credential": "LSCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mindy Brockmeyer
• Ashley L Brockus, LMFT
• Bryan Spencer Brockus Jr., LMFT-T
• Shawn Michael Brockus, LPC-T
• Bryan Keith Broddle, CRNA
• Andrew Brogan, PA-C
• Desiree K Brogan, APRN
• Melinda Bron, MD
• Tyler Bron, MD
• Brookdale Senior Living Communities, Inc.

• Clinical Social Worker in Wichita, KS
• Providers in Wichita, KS by specialty
• Clinical Social Worker in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.