Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

SHANNON BRODERICK LSCSW
NPI 1386096790
Social Worker - Clinical in Wichita, KS

Q: What is Shannon Broderick's NPI number?

The NPI number for Shannon Broderick is 1386096790. It was assigned to this individual provider in the NPPES registry on July 9, 2016. The provider is also known as Shannon Fleetwood Lscsw.

Q: What is Shannon Broderick's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Shannon Broderick was last updated on June 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 56 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 09, 2016

801 E DOUGLAS AVE FL 2, WICHITA, KS 67202(646) 941-7645(929) 596-7897 Get Directions Write a Review

NPPES record last updated: June 16, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Shannon Broderick Lscsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANNON BRODERICK LSCSW (NPI 1386096790) is an individual clinical provider in Wichita, Kansas, licensed in Kansas (07235) and active in the NPI registry since July 2016.

NPPES Registry Identity

NPI1386096790

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameSHANNON BRODERICKCredential: LSCSW

Location Address801 E DOUGLAS AVE FL 2Wichita, KS 67202-3548

Mailing Address801 E Douglas Ave Fl 2Wichita, KS 67202-3548 · (646) 941-7645 · Fax (929) 596-7897

Phone(646) 941-7645

Fax(929) 596-7897

Sole ProprietorNo

Enumeration DateJuly 9, 2016

Last NPPES UpdateJune 16, 2026

NPPES CertifiedJune 16, 2026

✔ NPI 1386096790 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in KS · 07235

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Also ListedSocial WorkerTaxonomy 104100000X · License 10002 (KS), 2016027520 (MO)

801 E DOUGLAS AVE FL 2, Wichita, KS 67202

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Other Names 1

Former Name (1)Shannon Fleetwood Lscsw

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FORM ASSOCIATES, P.A.

Internal Medicine (Endocrinology, Diabetes & Metabolism)