Healthcare Provider Details

I. General information

NPI: 1881769404
Provider Name (Legal Business Name): SUSAN THOMPSON LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 W 83RD ST STE 204
PRAIRIE VILLAGE KS
66208-5323
US

IV. Provider business mailing address

6001 W 62ND ST
MISSION KS
66202-3539
US

V. Phone/Fax

Practice location:
  • Phone: 913-481-4004
  • Fax:
Mailing address:
  • Phone: 913-481-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1064
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: