Provider Demographics
NPI:1427143585
Name:VANWAZER, SUE (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:
Last Name:VANWAZER
Suffix:
Gender:F
Credentials:MA, LPC
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 28727
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64188-8727
Mailing Address - Country:US
Mailing Address - Phone:816-545-9428
Mailing Address - Fax:
Practice Address - Street 1:8341 NW MACE RD
Practice Address - Street 2:STE 110
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-4618
Practice Address - Country:US
Practice Address - Phone:816-545-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001866101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOUDMedicaid