Provider Demographics
NPI:1114962750
Name:BROOKS HART, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BROOKS HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 COLLEGE BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1799
Mailing Address - Country:US
Mailing Address - Phone:913-338-0400
Mailing Address - Fax:913-338-0428
Practice Address - Street 1:4500 COLLEGE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1799
Practice Address - Country:US
Practice Address - Phone:913-338-0400
Practice Address - Fax:913-338-0428
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO22915053OtherBC&BS OF KC
KSS19747Medicare UPIN
KS0009202AMedicare ID - Type Unspecified