Healthcare Provider Details

I. General information

NPI: 1407772049
Provider Name (Legal Business Name): SHAWNTELLE LANETTE FISHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7267 NATURAL BRIDGE RD
SAINT LOUIS MO
63121-5045
US

IV. Provider business mailing address

7267 NATURAL BRIDGE RD
SAINT LOUIS MO
63121-5045
US

V. Phone/Fax

Practice location:
  • Phone: 314-381-0401
  • Fax: 314-381-1009
Mailing address:
  • Phone: 314-381-0401
  • Fax: 314-381-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020032730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: