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NPI Code Detail

MEDICARE: SHANNON N BURGESS MSW, LSW

MEDICARE:   SHANNON N BURGESS  MSW, LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerS.1600945OH
2104100000XSocial WorkerS.1600945OH

General Provider Information

NPI Number : 1205324928
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON N BURGESS MSW, LSW
Provider Business Mailing Address
First Line : 3293 KILDARE RD
Second Line :
City : CLEVELAND HTS
State : OH
Zip : 44118-2930
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1507 SAINT CLAIR AVE NE # C
Second Line :
City : CLEVELAND
State : OH
Zip : 44114-2003
Country : US
Telephone Number : 216-451-5020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2018
Last Update Date : 05/23/2022

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Directions to “ SHANNON N BURGESS MSW, LSW” Practice Location

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