Healthcare Provider Details

I. General information

NPI: 1740459940
Provider Name (Legal Business Name): SUZANNE D HEFFNER LCMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 W 110TH ST SUITE 304
OVERLAND PARK KS
66210-1865
US

IV. Provider business mailing address

8575 W 110TH ST SUITE 304
OVERLAND PARK KS
66210-1865
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-9333
  • Fax: 913-345-9335
Mailing address:
  • Phone: 913-345-9333
  • Fax: 913-345-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number325
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2004034483
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: