MEDICARE: SUE ELLEN MYERS

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	2002006591	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	:	1992869432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE ELLEN MYERS

Provider Business Mailing Address
First Line	:	1012 GREYSTONE CT
Second Line	:
City	:	FULTON
State	:	MO
Zip	:	65251-1297
Country	:	US
Telephone Number	:	573-642-5345
Fax Number	:	573-642-0891

Provider Business Practice Location Address
First Line	:	8548 JADE ROAD
Second Line	:
City	:	KINGDOM CITY
State	:	MO
Zip	:	65262
Country	:	US
Telephone Number	:	573-642-5345
Fax Number	:	573-642-5345

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/09/2007

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Directions to “ SUE ELLEN MYERS ” Practice Location

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