Healthcare Provider Details

I. General information

NPI: 1679162853
Provider Name (Legal Business Name): SHANNA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNA ARNOLD

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 03/10/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 WALTON DR
FARMINGTON MO
63640
US

IV. Provider business mailing address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

V. Phone/Fax

Practice location:
  • Phone: 573-760-8360
  • Fax: 573-760-8360
Mailing address:
  • Phone: 314-206-3700
  • Fax: 314-206-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: