Provider Demographics
NPI:1790181063
Name:SUSAN J. ANDERSON, PSY.D., PA
Entity Type:Organization
Organization Name:SUSAN J. ANDERSON, PSY.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:/PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:913-353-5993
Mailing Address - Street 1:8500 W 110TH ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1874
Mailing Address - Country:US
Mailing Address - Phone:913-353-5993
Mailing Address - Fax:844-800-3062
Practice Address - Street 1:8500 W. 100TH STREET
Practice Address - Street 2:540
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210
Practice Address - Country:US
Practice Address - Phone:913-353-5993
Practice Address - Fax:844-800-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1767103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty