Individual
SUSAN DIANE NIMROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
3515 S 4TH STREET, PROFESSIONAL ASSOCIATION, LEAVENWORTH, KS 66048
(913) 651-8415
(913) 772-8580
Mailing address
PO BOX 860513, SHAWNEE MISSION, KS 66286
(913) 530-0158
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2000152681
MO
101Y00000X
Counselor
Primary
213
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33078027
BCBS KANSAS
KS
Enumeration date
10/19/2006
Last updated
07/08/2007
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