Individual
EVANGELINE SUPPES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1339 S 20TH ST, SAINT JOSEPH, MO 64507-1246
(913) 636-7932
Mailing address
1115 E PENCE RD, CAMERON, MO 64429-8804
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
05276
KS
1041C0700X
Clinical Social Worker
2019045985
MO
Other
Enumeration date
11/18/2020
Last updated
01/19/2025
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