Healthcare Provider Details

I. General information

NPI: 1154943009
Provider Name (Legal Business Name): SHANNON WILKERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 NORTH BLVD
BATON ROUGE LA
70806-3825
US

IV. Provider business mailing address

4550 NORTH BLVD STE 250
BATON ROUGE LA
70806-4013
US

V. Phone/Fax

Practice location:
  • Phone: 225-655-6422
  • Fax: 225-341-5903
Mailing address:
  • Phone: 259-271-7432
  • Fax: 225-927-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6383
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: