Provider Demographics
NPI:1609939693
Name:CORDES, CHERYL SUANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:SUANN
Last Name:CORDES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 BROADWAY ST
Mailing Address - Street 2:312
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2658
Mailing Address - Country:US
Mailing Address - Phone:816-753-3837
Mailing Address - Fax:816-931-5821
Practice Address - Street 1:3100 BROADWAY ST
Practice Address - Street 2:312
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2658
Practice Address - Country:US
Practice Address - Phone:816-753-3837
Practice Address - Fax:816-931-5821
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS000584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20228012 SPEC105OtherBCBS