Provider Demographics
NPI:1245485523
Name:SHUMAN, SUSAN L (PSYD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:SHUMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:902 EDMOND ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-2749
Mailing Address - Country:US
Mailing Address - Phone:816-364-4300
Mailing Address - Fax:816-279-8148
Practice Address - Street 1:902 EDMOND ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-2749
Practice Address - Country:US
Practice Address - Phone:816-364-4300
Practice Address - Fax:816-279-8148
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009030855103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245485523OtherNPI
12114205OtherCAQH