Provider Demographics
NPI:1861797201
Name:HANNEMANN, SHAWN ANN (MS)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:ANN
Last Name:HANNEMANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 S 74TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3009
Mailing Address - Country:US
Mailing Address - Phone:920-475-4138
Mailing Address - Fax:
Practice Address - Street 1:5700 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1442
Practice Address - Country:US
Practice Address - Phone:414-421-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-16
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI496926225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist