Provider Demographics
NPI:1952130650
Name:GRUZESKI, SHANNON MEREDITH
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MEREDITH
Last Name:GRUZESKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HUBER PARK CT STE 103
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8683
Mailing Address - Country:US
Mailing Address - Phone:314-527-1566
Mailing Address - Fax:
Practice Address - Street 1:500 HUBER PARK CT STE 103
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-8683
Practice Address - Country:US
Practice Address - Phone:314-527-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional