MEDICARE: MRS. SHANNON ARMSTRONG ANNISON LCSW

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
1	1041C0700X	Clinical Social Worker	5727	LA

General Provider Information

NPI Number	:	1952401549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON ARMSTRONG ANNISON LCSW

Provider Business Mailing Address
First Line	:	36038 WILMINGTON AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-1523
Country	:	US
Telephone Number	:	225-664-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	36038 WILMINGTON AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-1523
Country	:	US
Telephone Number	:	225-664-6598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/08/2007

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