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General NPI Number Information
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NPI Number | 1790181063
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Entity Type | Organization
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Legal Business Name | SUSAN J. ANDERSON, PSY.D., PA
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 8500 W. 100TH STREET 540
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City | OVERLAND PARK
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State | KS
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Zip | 66210
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Country | US
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Telephone | 913-353-5993
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Fax | 844-800-3062
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Provider Business Mailing Address
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Address Line | 8500 W 110TH ST SUITE 540
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City | OVERLAND PARK
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State | KS
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Zip | 66210-1874
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Country | US
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Telephone | 913-353-5993
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Fax | 844-800-3062
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Authorized Official
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Title or Position | /PSYCHOLOGIST/OWNER
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Name | DR. SUSAN JOAN ANDERSON
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Credential | PSY.D.
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Telephone | 913-353-5993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1767
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License Number State | KS
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