Provider Demographics
NPI:1962660597
Name:SUSAN DROE INC.
Entity Type:Organization
Organization Name:SUSAN DROE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DROE-PUNZO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:816-752-8196
Mailing Address - Street 1:3438 ASHLAND AVE
Mailing Address - Street 2:SUITE X
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1333
Mailing Address - Country:US
Mailing Address - Phone:816-752-8196
Mailing Address - Fax:816-364-2725
Practice Address - Street 1:3438 ASHLAND AVE
Practice Address - Street 2:SUITE X
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1333
Practice Address - Country:US
Practice Address - Phone:816-752-8196
Practice Address - Fax:816-364-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002105251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR920000Medicare PIN