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NPI Code Detail

MEDICARE: MRS. SUSAN ELIZABETH STEVENSON MOORE MSW LCSW

MEDICARE: MRS. SUSAN ELIZABETH STEVENSON MOORE MSW LCSW
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
11041C0700XClinical Social Worker006256MO

General Provider Information

NPI Number : 1831172436
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN ELIZABETH STEVENSON MOORE MSW LCSW
Provider Business Mailing Address
First Line : 1800 COMMUNITY
Second Line :
City : CLINTON
State : MO
Zip : 64735-8804
Country : US
Telephone Number : 844-853-8937
Fax Number : 660-885-3690
Provider Business Practice Location Address
First Line : 1032 CROSSWINDS CT
Second Line :
City : WENTZVILLE
State : MO
Zip : 63385-4836
Country : US
Telephone Number : 844-853-8937
Fax Number : 660-885-3690
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 05/12/2026

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