Individual provider Active NPI

Shadow-Lyte Jasmin Donavan, LCSW, LMT

  • Clinical Social Worker
  • Waunakee, WI
National Provider Identifier
1962057463
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6526-123 Issued in WI
Practice address
251 Progress Way
Waunakee, WI 53597-2520
Phone
(608) 409-3400
NPI assigned
Aug 2, 2019
Last updated
Jul 7, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6526-123 WI Primary

Addresses

Primary practice location

251 Progress Way
Waunakee, WI 53597-2520

Mailing address

1950 Foggy Mountain Pass
Waunakee, WI 53597-2383
Phone (608) 409-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200225002941 WI Practitioner - Clinical Social Worker 8123455466 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Four Winds Counseling LLCGroup PAC ID 1850747270, 6 clinicians

Practice addresses (Care Compare)

8500 Greenway Blvd
Suite 102
Middleton, WI 53562-4713
Phone (608) 516-1734

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6526-123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
S M Backus LLC Clinical CurrentSince Nov 9, 2025 Accepting new patients

Locations

2415 Parview Rd
Ste 1
Middleton, WI 53562
Phone (608) 409-3400

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1962057463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 FOGGY MOUNTAIN PASS",
            "city": "WAUNAKEE",
            "state": "WI",
            "postal_code": "535972383",
            "telephone_number": "608-409-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 PROGRESS WAY",
            "city": "WAUNAKEE",
            "state": "WI",
            "postal_code": "535972520",
            "telephone_number": "608-409-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JASMIN DONAVAN",
        "first_name": "SHADOW-LYTE",
        "credential": "LCSW, LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-02",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "6526-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waunakee, WI

Sources for this page

Verify at the official NPI Registry.