Individual
DR. SUSAN L SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
7400 HIGHWAY N, O FALLON, MO 63368-7013
(636) 561-7080
(636) 561-0463
Mailing address
311 NAUTICA LN, LAKE ST LOUIS, MO 63367-2658
(636) 561-1788
(636) 561-0463
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2000166718
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168991
BLUE CROSS BLUE SHIELD
MO
05
—
495069304
—
MO
Enumeration date
12/18/2006
Last updated
07/09/2007
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