Provider Demographics
NPI:1801409412
Name:LYNCH, SHANNON MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 CLARKSON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2497
Mailing Address - Country:US
Mailing Address - Phone:636-256-0600
Mailing Address - Fax:
Practice Address - Street 1:249 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2497
Practice Address - Country:US
Practice Address - Phone:636-256-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker