Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 2000148174 | MO |
Y | 101YS0200X | School Counselor | 2000148174 | MO |
NPI | 1194999045 |
---|---|
Provider Name | Mrs. Suzanne A Landis |
First Address | Saint Louis, MO 63132-4310 |
Second Address | Webster Groves, MO 63119-3107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 05/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194999045 | (05) | MO |