Provider Demographics
NPI:1699335448
Name:SHEKELS, STEVEN OTIS
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:OTIS
Last Name:SHEKELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5879 ELK LN
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53964-8822
Mailing Address - Country:US
Mailing Address - Phone:608-548-8583
Mailing Address - Fax:
Practice Address - Street 1:134 W HURON ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1571
Practice Address - Country:US
Practice Address - Phone:920-290-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst