Susan L Sanderson, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2000166718 Issued in MO

Practice address

7400 Highway N
O Fallon, MO 63368-7013

Phone

(636) 561-7080

Fax

(636) 561-0463

NPI assigned

Dec 18, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1487717963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 NAUTICA LN",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633672658",
            "telephone_number": "636-561-1788",
            "fax_number": "636-561-0463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 HIGHWAY N",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633687013",
            "telephone_number": "636-561-7080",
            "fax_number": "636-561-0463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "SUSAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2000166718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "168991",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "495069304",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Saint
• Harold Douglas Sammons, D.C.
• Rachel Sammons, RN, IBCLC
• Stephanie L Sandberg, D.O.
• Jenna A Sanders, ANP-C
• Sandhill Counseling and Consultation, LLC
• Jessica Lauren Sanford, MD
• Victoria Sanford, PMHMP-BC
• Sarah Gleason Registered Dietitian
• Sarah Puzey LLC (Periodontics of O'Fallon)

• Clinical Psychologist in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.