Provider Demographics
NPI:1972938074
Name:ESKRIDGE, SHELLENA (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:SHELLENA
Middle Name:
Last Name:ESKRIDGE
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3264 REX AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-2927
Mailing Address - Country:US
Mailing Address - Phone:415-722-8302
Mailing Address - Fax:
Practice Address - Street 1:3264 REX AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-2927
Practice Address - Country:US
Practice Address - Phone:415-722-8302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-08
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011031268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker