Healthcare Provider Details

I. General information

NPI: 1831373547
Provider Name (Legal Business Name): SHANNON SMITH BLESTEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 FREMAUX AVE
SLIDELL LA
70458-3319
US

IV. Provider business mailing address

59294 W HARBOR LN
LACOMBE LA
70445-3692
US

V. Phone/Fax

Practice location:
  • Phone: 985-771-1742
  • Fax: 866-593-6775
Mailing address:
  • Phone: 985-771-1742
  • Fax: 866-593-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3595
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: