MEDICARE: SALINA CONNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.190805	OH
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1073401402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALINA CONNER

Provider Business Mailing Address
First Line	:	4269 PEARL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-4234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 CLINTON AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-2808
Country	:	US
Telephone Number	:	216-678-8084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	12/16/2025

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Directions to “ SALINA CONNER ” Practice Location

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