Healthcare Provider Details

I. General information

NPI: 1013833144
Provider Name (Legal Business Name): VONNA SUDA EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S LEAD ST
POTOSI MO
63664-1823
US

IV. Provider business mailing address

10725 PEPPERSVILLE RD
BLACKWELL MO
63626-9568
US

V. Phone/Fax

Practice location:
  • Phone: 573-438-2977
  • Fax:
Mailing address:
  • Phone: 573-436-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number71820
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: