Active NPI
Susan Marie Southworth, PSY.D.
- Psychologist
- Kearney, MO
National Provider Identifier
1235313719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY01928
- Practice address
- 310 S Platte Clay Way
Suite C
Kearney, MO 64060-8797 - Phone
- (816) 914-5322
- Fax
- (816) 628-5452
- NPI assigned
- Dec 20, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY01928 | MO | Primary |
Addresses
Primary practice location
310 S Platte Clay Way
Suite C
Kearney, MO 64060-8797
Mailing address
310 S Platte Clay Way
Suite C
Kearney, MO 64060-8797
Phone (816) 914-5322
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY01928 | MO | MD | Psychologist |
| 01928 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373587200000",
"number": "1235313719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 S PLATTE CLAY WAY",
"address_2": "SUITE C",
"city": "KEARNEY",
"state": "MO",
"postal_code": "640608797",
"telephone_number": "816-914-5322",
"fax_number": "816-628-5452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 S PLATTE CLAY WAY",
"address_2": "SUITE C",
"city": "KEARNEY",
"state": "MO",
"postal_code": "640608797",
"telephone_number": "816-914-5322",
"fax_number": "816-628-5452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHWORTH",
"first_name": "SUSAN",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-20",
"last_updated": "2013-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "PY01928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kearney, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.