Sue Ellen Myers
Individual provider Active NPI Clinical Social Worker · Kingdom City, MO
NPI 1992869432 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1992869432
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 2002006591 (MO)
- Practice address
- 8548 Jade Road
Kingdom City, MO 65262 - Phone
- (573) 642-5345
- Fax
- (573) 642-5345
- NPI assigned
- Dec 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002006591 | MO | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri Girls Town Foundation, Inc | Past |
Accepting new patients | |
| Missouri Girls Town Foundation, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2002006591 | MO | Yes |
Addresses
Primary practice location
8548 Jade Road
Kingdom City, MO 65262
Mailing address
1012 Greystone CT
Fulton, MO 65251-1297
Phone (573) 642-5345
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 495246308 | Medicaid | MO |
Other providers in Kingdom City, MO
- Jennifer L. Kalyango
- Tobi Lee Linneman
- Mariette Adcock Lovinger
- Missouri Girls Town Foundation, Inc
- Missouri Girls Town Foundation, Inc
- North Callaway Fire Protection Dist
- North Callaway R-1 School District
- Katherine Marie O'Neal
- Emily Nicole Rowland
- James Lee Smiley
All providers in Kingdom City, MO · Clinical Social Worker in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.