MEDICARE: MS. SHADEAU LEA RHODES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	7952	TN
2	104100000X	Social Worker	11304	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1023778461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHADEAU LEA RHODES LCSW

Provider Business Mailing Address
First Line	:	140 S MAIN ST STE 19
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-3058
Country	:	US
Telephone Number	:	901-308-6991
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 S MAIN ST STE 19
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-3058
Country	:	US
Telephone Number	:	901-308-6991
Fax Number	:	901-231-7905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2021
Last Update Date	:	03/27/2026

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