Provider Demographics
NPI:1013612241
Name:KOENIGSFELD, SHANNON KELLY (PLPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:KELLY
Last Name:KOENIGSFELD
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-2525
Mailing Address - Country:US
Mailing Address - Phone:314-769-5283
Mailing Address - Fax:
Practice Address - Street 1:2002 WYOMING ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-2525
Practice Address - Country:US
Practice Address - Phone:314-769-5283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023006983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health