Provider Demographics
NPI:1952693533
Name:SHANNON-MCGOWAN, ERIN COLLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:COLLEEN
Last Name:SHANNON-MCGOWAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6800
Mailing Address - Country:US
Mailing Address - Phone:314-409-5214
Mailing Address - Fax:
Practice Address - Street 1:443 N NEW BALLAS RD
Practice Address - Street 2:SUITE 224
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6800
Practice Address - Country:US
Practice Address - Phone:314-409-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003024793103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical