Provider Demographics
NPI:1831498955
Name:MCDOWELL, SUSAN JANETTE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JANETTE
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S WOODWARD ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MO
Mailing Address - Zip Code:64443
Mailing Address - Country:US
Mailing Address - Phone:816-344-4392
Mailing Address - Fax:
Practice Address - Street 1:11960 WESTLINE INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3209
Practice Address - Country:US
Practice Address - Phone:314-819-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117346172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker