Healthcare Provider Details

I. General information

NPI: 1053936302
Provider Name (Legal Business Name): SHAYNA WARNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12141 LADUE RD
SAINT LOUIS MO
63141-8120
US

IV. Provider business mailing address

12141 LADUE RD
SAINT LOUIS MO
63141-8120
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-4340
  • Fax: 314-878-4524
Mailing address:
  • Phone: 314-878-4340
  • Fax: 314-878-4524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020000398
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: