Provider Demographics
NPI:1891892873
Name:DAVIS, SUSAN A (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:DAVIS
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 1:2121 MEADOWLARK RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-4556
Mailing Address - Country:US
Mailing Address - Phone:785-537-4610
Mailing Address - Fax:785-537-3022
Practice Address - Street 1:2121 MEADOWLARK RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4556
Practice Address - Country:US
Practice Address - Phone:785-537-4610
Practice Address - Fax:785-537-3022
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 20651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069578OtherPROVIDER NUMBER
KSP48479Medicare UPIN
KS180502Medicare ID - Type UnspecifiedMEDICARE NUMBER