Lucinda Susan Shannon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW889 Issued in ID

Practice address

2201 Ironwood Place
Coeur D Alene, ID 83814

Phone

(208) 769-4222

Fax

(844) 803-7399

NPI assigned

Aug 23, 2005

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Dirne Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Coeur D Alene, ID
  • NPI 1720564271

  Clinical

  NPD (past)

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1962495259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1387",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838351387",
            "telephone_number": "208-415-0299",
            "fax_number": "208-625-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 IRONWOOD PLACE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-769-4222",
            "fax_number": "844-803-7399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "LUCINDA",
        "middle_name": "SUSAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-23",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800012721",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "HPS21",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mario J Seyer, DO
• Lauren Seymour, BS
• Laura S Sferra, LCPC
• Sheyenne Shamburg
• Raina Shanks, D.O.
• Morgan Jaye McCardell Shannon, NP
• James Sharp, PHARMD
• Stuart T Sharp, PA
• Alyssa Anes Shaw, M.D.
• Daniel J Shaw, DDS

• Clinical Social Worker in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.