Provider Demographics
NPI:1093933350
Name:SUE DOWD PHD LLC
Entity Type:Organization
Organization Name:SUE DOWD PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOWD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:620-424-4554
Mailing Address - Street 1:303 NORTH KANSAS
Mailing Address - Street 2:SUITE A104
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901
Mailing Address - Country:US
Mailing Address - Phone:620-624-2900
Mailing Address - Fax:620-624-4050
Practice Address - Street 1:303 N KANSAS AVE
Practice Address - Street 2:SUITE A104
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-3339
Practice Address - Country:US
Practice Address - Phone:620-624-2900
Practice Address - Fax:620-624-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200362670AMedicaid
KS111150OtherBLUE CROSS BLUE SHIELD
KS111150OtherBLUE CROSS BLUE SHIELD