Shannon C Schaefer, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2632-057 Issued in WI

Practice address

2620 Stewart Ave
Suite 318
Wausau, WI 54401-4170

Phone

(715) 842-9500

Fax

(715) 848-0425

NPI assigned

Aug 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Shannon C Lee Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

• Behavioral Health Clinic, LLC

  • Clinical Psychologist
  • Wausau, WI
  • NPI 1831442359
  Medicare reassignment

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350259200000",
    "number": "1972616795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 STEWART AVE",
            "address_2": "SUITE 318",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014170",
            "telephone_number": "715-842-9500",
            "fax_number": "715-848-0425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 STEWART AVE",
            "address_2": "SUITE 318",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014170",
            "telephone_number": "715-842-9500",
            "fax_number": "715-848-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHAEFER",
        "first_name": "SHANNON",
        "middle_name": "C",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2012-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2632-057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "LEE",
            "middle_name": "C",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ricky L. Scalcucci, O.D
• Kristin Scandin, OT
• Michael John Scandin, PT LAT
• Riley Scanlan
• Kenneth Russell Schaefer, RPH
• Amanda Jean Schafer, LPC
• Ivan B. Schaller, MD
• Tyler Scharbarth
• Jennifer Scharenbrock, PT, DPT
• Scharer Spinal Aid Centers S C

• Clinical Psychologist in Wausau, WI
• Providers in Wausau, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.