Provider Demographics
NPI:1831767052
Name:STRAUSER, SHANE ADAM I (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:ADAM
Last Name:STRAUSER
Suffix:I
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4433 RAVEN PT
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-3814
Mailing Address - Country:US
Mailing Address - Phone:314-705-1584
Mailing Address - Fax:
Practice Address - Street 1:4433 RAVEN PT
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-3814
Practice Address - Country:US
Practice Address - Phone:314-705-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040266601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical