Provider Demographics
NPI:1548221203
Name:WIMMER, SHELLEY JEANNE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:JEANNE
Last Name:WIMMER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1970 ROANOKE BLVD
Mailing Address - Street 2:MAIL CODE 020A
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:540-855-5012
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:MAIL CODE 020A
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-855-5012
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical