Individual
SUSAN STACKELHOUSE VOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5525
(573) 632-5811
Mailing address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5525
(573) 632-5811
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
113335
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11071
CIGNA
—
01
—
129170
BLUE CROSS BLUE SHIELD
—
01
—
1834230
FIRST HEALTH
—
01
—
204990105
MEDICAID
MO
05
—
204990105
—
MO
01
—
207515500
MEDICAID
MO
01
—
440546366
UNITED HEALTH CARE
—
01
—
H16641
MERCY
—
Enumeration date
04/20/2006
Last updated
02/11/2016
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