Provider Demographics
NPI:1063559284
Name:CANNON, SUSAN (PT, DPT, MSED)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:PT, DPT, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-492-1201
Mailing Address - Fax:913-588-5916
Practice Address - Street 1:CENTER FOR CHILD HEALTH AND DEVELOPMENT
Practice Address - Street 2:3901 RAINBOW BLVD., MAIL STOP 4003
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-5588
Practice Address - Fax:913-588-5916
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11007402080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics