Provider Demographics
NPI:1033640644
Name:SMITH, SHANNON ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W RED BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-5136
Mailing Address - Country:US
Mailing Address - Phone:816-942-8772
Mailing Address - Fax:
Practice Address - Street 1:212 W RED BRIDGE RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-5136
Practice Address - Country:US
Practice Address - Phone:816-942-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060384951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical