Healthcare Provider Details

I. General information

NPI: 1407424104
Provider Name (Legal Business Name): SHANNON SOBECK MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date: 08/13/2025
Reactivation Date: 09/25/2025

III. Provider practice location address

1804 LAFAYETTE AVE
SAINT LOUIS MO
63104-2508
US

IV. Provider business mailing address

1804 LAFAYETTE AVE
SAINT LOUIS MO
63104-2508
US

V. Phone/Fax

Practice location:
  • Phone: 314-296-3222
  • Fax:
Mailing address:
  • Phone: 314-296-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2025019960
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: