Provider Demographics
NPI:1255056065
Name:SUSAN LANGSTRAAT LCSW LLC
Entity type:Organization
Organization Name:SUSAN LANGSTRAAT LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISNESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-963-0958
Mailing Address - Street 1:2151 COUNTY ROAD 228
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-3449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2151 COUNTY ROAD 228
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-3449
Practice Address - Country:US
Practice Address - Phone:573-999-6207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health