Healthcare Provider Details

I. General information

NPI: 1972938074
Provider Name (Legal Business Name): SHELLENA ESKRIDGE MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2013
Last Update Date: 09/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3264 REX AVE
SAINT LOUIS MO
63114-2927
US

IV. Provider business mailing address

3264 REX AVE
SAINT LOUIS MO
63114-2927
US

V. Phone/Fax

Practice location:
  • Phone: 415-722-8302
  • Fax:
Mailing address:
  • Phone: 415-722-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2011031268
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: