Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shelly Bourquin, LCSW

Individual provider Social Worker · NPI 1689108250

Shelly Bourquin, LCSW is a Clinical Social Worker in Waukesha, Wisconsin. Qualified in 2016, 10 years ago. Practices with Prohealth Medical Group Inc, a 472-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
10
Licensed in
WI
In the registry since
2017
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

514 Riverview Ave
Waukesha, WI 53188-3631
Phone: (262) 548-7666
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 9229 (WI)
Social Worker Taxonomy 104100000X · Licence 130442 (WI)

Record details

NPI number1689108250
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedApril 20, 2017
Last updated in NPPESMay 21, 2025
Certification dateMay 21, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Prohealth Medical Group Inc — 472 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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