MEDICARE: MS. SUE VANWAZER MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	001866	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427143585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE VANWAZER MA, LPC

Provider Business Mailing Address
First Line	:	PO BOX 28727
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64188-8727
Country	:	US
Telephone Number	:	816-545-9428
Fax Number	:

Provider Business Practice Location Address
First Line	:	8341 NW MACE RD
Second Line	:	STE 110
City	:	KANSAS CITY
State	:	MO
Zip	:	64152-4618
Country	:	US
Telephone Number	:	816-545-9428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/22/2014

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