Healthcare Provider Details

I. General information

NPI: 1588580526
Provider Name (Legal Business Name): SHANNON BAEHR LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 FOREST PKWY STE 100
NORTH TONAWANDA NY
14120-3764
US

IV. Provider business mailing address

PO BOX 328
LOCKPORT NY
14095-0328
US

V. Phone/Fax

Practice location:
  • Phone: 716-869-1024
  • Fax: 716-419-5129
Mailing address:
  • Phone: 716-869-1024
  • Fax: 716-419-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SHANNON BAEHR
Title or Position: PROVIDER/CEO
Credential: LCSW
Phone: 716-869-1024