Provider Demographics
NPI:1528711637
Name:DORVILIER, SHAWANNA (APSW)
Entity type:Individual
Prefix:MRS
First Name:SHAWANNA
Middle Name:
Last Name:DORVILIER
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5828 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-1836
Mailing Address - Country:US
Mailing Address - Phone:414-745-0631
Mailing Address - Fax:
Practice Address - Street 1:3505 N 124TH ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2489
Practice Address - Country:US
Practice Address - Phone:414-431-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132591-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker