Provider Demographics
NPI:1912203043
Name:PATTERSON, SUSAN MARIE (ACSW,LMSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:ACSW,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 45TH RD SE
Mailing Address - Street 2:
Mailing Address - City:AGENCY
Mailing Address - State:MO
Mailing Address - Zip Code:64401-8104
Mailing Address - Country:US
Mailing Address - Phone:919-394-5317
Mailing Address - Fax:913-381-3307
Practice Address - Street 1:12110 45TH RD SE
Practice Address - Street 2:
Practice Address - City:AGENCY
Practice Address - State:MO
Practice Address - Zip Code:64401-8104
Practice Address - Country:US
Practice Address - Phone:919-394-5317
Practice Address - Fax:913-381-3307
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7505104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker