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General NPI Number Information
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NPI Number | 1922137793
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Entity Type | Individual
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Provider Name | SHIRLEY DIANE CRENSHAW MSW, L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 11030 SCHUETZ ROAD
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4972
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Country | US
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Telephone | 314-374-4753
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Fax | 314-222-4939
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Provider Business Mailing Address
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Address Line | 11030 SCHUETZ ROAD
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4972
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Country | US
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Telephone | 314-374-4753
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Fax | 314-222-4939
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.009685
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 005158
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License Number State | MO
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