Shannon Kostuck, MSW, LCSW-A

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P007907 Issued in NC

Practice address

2101 Peters Creek Pkwy
Suite 20-22
Winston Salem, NC 27127-3726

Phone

(336) 761-5300

Fax

(336) 761-5319

NPI assigned

Nov 20, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 1, 2025 through Oct 1, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rivulet Clinical Services

  • Clinical Social Worker
  • Madison, WI
  • NPI 1841973328
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384905600000",
    "number": "1568892016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 PETERS CREEK PKWY",
            "address_2": "SUITE 20-22",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271273726",
            "telephone_number": "336-761-5300",
            "fax_number": "336-761-5319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 PETERS CREEK PKWY",
            "address_2": "SUITE 20-22",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271273726",
            "telephone_number": "336-761-5300",
            "fax_number": "336-761-5319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTUCK",
        "first_name": "SHANNON",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-20",
        "last_updated": "2013-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P007907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carla Mann Koskinas, PA-C
• Brian R Kosobucki, M.D.
• Kostelic & Associates 2, PLLC
• Phillip Martin Kostelic
• Paul J Kostuchenko, MD
• Joshua Kota
• Patrick P Koty, PHD
• Joanna Koudele Koudele, DPT
• Lois Elinor Koufman, LPC
• Ana Elena Kouri, MD

• Clinical Social Worker in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.