Provider Demographics
NPI:1245094853
Name:SERAFIN, SHANNON IRENE (BCBA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:IRENE
Last Name:SERAFIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 BARRINGTON PL
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-3206
Mailing Address - Country:US
Mailing Address - Phone:414-301-2433
Mailing Address - Fax:
Practice Address - Street 1:3117 BARRINGTON PL
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-3206
Practice Address - Country:US
Practice Address - Phone:414-301-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1202-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst