Provider Demographics
NPI:1114985157
Name:GRACE, SUZANNE R (LMSW, LCSW, LSCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:GRACE
Suffix:
Gender:F
Credentials:LMSW, LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3017
Mailing Address - Country:US
Mailing Address - Phone:816-523-0454
Mailing Address - Fax:
Practice Address - Street 1:5424 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-3446
Practice Address - Country:US
Practice Address - Phone:913-287-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5811104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker