Provider Demographics
NPI:1346316882
Name:LIGHTFOOT, SHARON LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LYNN
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N NEWSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2637
Mailing Address - Country:US
Mailing Address - Phone:314-289-9981
Mailing Address - Fax:
Practice Address - Street 1:4974 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2010
Practice Address - Country:US
Practice Address - Phone:314-289-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPSY01292103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO70048Medicare ID - Type UnspecifiedPSYCHOLOGIST