MEDICARE: MS. SUSAN ANN MILLER LCSW, LSCSW, ACSW

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	1041C0700X	Clinical Social Worker	2001001529	MO
2	1041C0700X	Clinical Social Worker	1384	KS

General Provider Information

NPI Number	:	1639489784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN ANN MILLER LCSW, LSCSW, ACSW

Provider Business Mailing Address
First Line	:	1740 JEFFERSON ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1104
Country	:	US
Telephone Number	:	816-471-2536
Fax Number	:	816-471-2521

Provider Business Practice Location Address
First Line	:	2405 ELMWOOD AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-4536
Country	:	US
Telephone Number	:	816-241-5252
Fax Number	:

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

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/07/2010

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