Provider Demographics
NPI:1346260395
Name:PLATT, SUSANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:
Last Name:PLATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-1010
Mailing Address - Country:US
Mailing Address - Phone:417-448-5919
Mailing Address - Fax:
Practice Address - Street 1:300 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-2202
Practice Address - Country:US
Practice Address - Phone:417-667-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0020901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34616011OtherBC/BS OF KANSAS CITY
MO499076008Medicaid
MO718C549Medicare Oscar/Certification
MO000C549Medicare ID - Type UnspecifiedEFFECTIVE DATE 06/01/2004