Provider Demographics
NPI:1639489784
Name:MILLER, SUSAN ANN (LCSW, LSCSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW, LSCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1104
Mailing Address - Country:US
Mailing Address - Phone:816-471-2536
Mailing Address - Fax:816-471-2521
Practice Address - Street 1:2405 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-4536
Practice Address - Country:US
Practice Address - Phone:816-241-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010015291041C0700X
KS13841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical