Healthcare Provider Details

I. General information

NPI: 1497967749
Provider Name (Legal Business Name): SHANNON MORGAN-GILLARD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKINGS DR
SAINT LOUIS MO
63130-4862
US

IV. Provider business mailing address

1201 BROOKINGS DR C B 1201
SAINT LOUIS MO
63130
US

V. Phone/Fax

Practice location:
  • Phone: 314-935-6649
  • Fax: 314-935-8515
Mailing address:
  • Phone: 314-935-6649
  • Fax: 314-935-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2006029893
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: