Provider Demographics
NPI:1538106877
Name:MULRYAN, SUSAN (LSCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MULRYAN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 7TH ST
Mailing Address - Street 2:PO BOX 173
Mailing Address - City:DWIGHT
Mailing Address - State:KS
Mailing Address - Zip Code:66849-9596
Mailing Address - Country:US
Mailing Address - Phone:785-564-0865
Mailing Address - Fax:
Practice Address - Street 1:221 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL GROVE
Practice Address - State:KS
Practice Address - Zip Code:66846-1704
Practice Address - Country:US
Practice Address - Phone:785-564-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069374OtherBCBS NUMBER
KSP19171Medicare UPIN
KS069374Medicare ID - Type UnspecifiedMEDICARE NUMBER