Individual
SHANNON WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
32 PORTWEST CT, SAINT CHARLES, MO 63303-5985
(636) 410-8292
Mailing address
1617 GRAPE AVE, SAINT LOUIS, MO 63147-1405
(314) 280-6366
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
2087
MO
310400000X
Assisted Living Facility
2087
MO
Other
Enumeration date
03/09/2026
Last updated
03/09/2026
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