Provider Demographics
NPI:1174080063
Name:RUSSELL, SHAYLA
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:
Other - Last Name:SCHERMETZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:OUTAGAMIE COUNTY HEALTH AND HUMAN SERVICES
Mailing Address - Street 2:320 S. WALNUT ST.
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911
Mailing Address - Country:US
Mailing Address - Phone:920-832-5270
Mailing Address - Fax:920-832-5488
Practice Address - Street 1:OUTAGAMIE COUNTY HEALTH AND HUMAN SERVICES
Practice Address - Street 2:320 S. WALNUT ST.
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911
Practice Address - Country:US
Practice Address - Phone:920-832-5270
Practice Address - Fax:920-832-5488
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2813-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health