Healthcare Provider Details

I. General information

NPI: 1326972720
Provider Name (Legal Business Name): MANIQUE SHANNON-BURNETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

200 NE 54TH ST STE 205
KANSAS CITY MO
64118-4389
US

IV. Provider business mailing address

7851 NW ROANRIDGE RD
KANSAS CITY MO
64151-1372
US

V. Phone/Fax

Practice location:
  • Phone: 816-355-4139
  • Fax:
Mailing address:
  • Phone: 913-707-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023035502
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: