Individual
DR. SUSAN LAUDERDALE WALDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3904 SW WINDSONG DR, LEES SUMMIT, MO 64082-4051
(660) 596-2400
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
(660) 826-4852
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY01834
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25323025
BLUE CROSS BLUE SHIELD ID
MO
05
—
498699511
—
MO
Enumeration date
11/20/2006
Last updated
08/27/2021
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