Provider Demographics
NPI:1568201671
Name:WACHTVEITL, SHELBRIA LEIGH-ANNE (MSW)
Entity type:Individual
Prefix:
First Name:SHELBRIA
Middle Name:LEIGH-ANNE
Last Name:WACHTVEITL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3722 KENDALL CT
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-3197
Mailing Address - Country:US
Mailing Address - Phone:262-325-2157
Mailing Address - Fax:
Practice Address - Street 1:N3722 KENDALL CT
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-3197
Practice Address - Country:US
Practice Address - Phone:262-325-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132273-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker