Provider Demographics
NPI:1609322536
Name:WEST, SHANNON (LMSW, LISW, LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:LMSW, LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4408
Mailing Address - Country:US
Mailing Address - Phone:563-320-7877
Mailing Address - Fax:
Practice Address - Street 1:322 E 15TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4408
Practice Address - Country:US
Practice Address - Phone:563-320-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082032101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health