Provider Demographics
NPI:1427647825
Name:WIETRZNY, SHANNON RENEE OLSON (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:RENEE OLSON
Last Name:WIETRZNY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:GARRETSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:N24W23870 TALON DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1830
Mailing Address - Country:US
Mailing Address - Phone:773-320-3098
Mailing Address - Fax:
Practice Address - Street 1:N17W24222 RIVERWOOD DR STE 170
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1134
Practice Address - Country:US
Practice Address - Phone:773-320-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8467-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical