Shadow-Lyte Jasmin Donavan, LCSW, LMT
Social Worker, Clinical in Waunakee, WI. Individual provider (NPI-1).
NPI number1962057463
StatusActive
Last updated in NPPESJul 7, 2026
Details
- NPI
- 1962057463
- Entity type
- Individual (NPI-1)
- Name
- Shadow-Lyte Jasmin Donavan
- Credential
- LCSW, LMT
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 2, 2019
- Certification date
- Jul 7, 2026
- Last updated
- Jul 7, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - CLINICAL SOCIAL WORKER
- Can order and refer
- Part B Yes · DME Yes · Home health No · Power mobility No · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 6526-123 | WI | Yes |
Practice location
251 Progress WayWaunakee, WI 53597-2520
Phone 608-409-3400
Mailing address
1950 Foggy Mountain PassWaunakee, WI 53597-2383
Phone 608-409-3400
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Clinical Social Worker providers in Waunakee, WI
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All 6 Clinical Social Worker providers in Waunakee · All 227 providers in Waunakee
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