Active NPI
Connie Faye Suderman, LSCSW
- Clinical Social Worker
- Wichita, KS
National Provider Identifier
1114100658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LSCSW - 4016
- Practice address
- 1660 N Tyler Rd
Suite a
Wichita, KS 67212-4917 - Phone
- (316) 722-4884
- Fax
- (316) 722-4893
- NPI assigned
- Dec 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LMSW-2560 | KS | |
| Clinical Social Worker | 1041C0700X | LSCSW - 4016 | KS | Primary |
Addresses
Primary practice location
1660 N Tyler Rd
Suite a
Wichita, KS 67212-4917
Mailing address
1660 N Tyler Rd
Suite a
Wichita, KS 67212-4917
Phone (316) 722-4884
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW-2560 | KS | MD | Clinical Social Worker |
| LSCSW - 4016 | KS | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385078400000",
"number": "1114100658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1660 N TYLER RD",
"address_2": "SUITE A",
"city": "WICHITA",
"state": "KS",
"postal_code": "672124917",
"telephone_number": "316-722-4884",
"fax_number": "316-722-4893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1660 N TYLER RD",
"address_2": "SUITE A",
"city": "WICHITA",
"state": "KS",
"postal_code": "672124917",
"telephone_number": "316-722-4884",
"fax_number": "316-722-4893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUDERMAN",
"first_name": "CONNIE",
"middle_name": "FAYE",
"credential": "LSCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-06",
"last_updated": "2013-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KS",
"license": "LMSW-2560",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KS",
"license": "LSCSW - 4016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.