Individual
MRS. IDA MAE SUTTMOLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LCSW CASAC
Contact information
Practice address
108 WEST JASPER, VERSAILLES, MO 65084
(573) 378-6833
(573) 378-6823
Mailing address
108 WEST JASPER, VERSALLIES, MO 65084
(573) 378-6833
(573) 378-6823
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
868
MO
1041C0700X
Clinical Social Worker
Primary
003970
MO
Other
Enumeration date
06/01/2009
Last updated
06/01/2009
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