Provider Demographics
NPI:1750661575
Name:RUETER, SHANNON RENE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENE
Last Name:RUETER
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 1:1715 FM 1626
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3553
Mailing Address - Country:US
Mailing Address - Phone:512-981-7046
Mailing Address - Fax:512-717-7246
Practice Address - Street 1:1121 E 7TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3220
Practice Address - Country:US
Practice Address - Phone:512-454-3743
Practice Address - Fax:512-334-4465
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX552591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical