=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932414802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN BARNGROVER PHD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2010
-----------------------------------------------------
Last Update Date | 08/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 SE DOUGLAS ST
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64063-4246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-524-5818
-----------------------------------------------------
Fax | 816-524-5819
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 SE DOUGLAS ST
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64063-4246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-524-5818
-----------------------------------------------------
Fax | 816-524-5819
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SUSAN F BARNGROVER
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 816-524-5818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY1402
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------