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NPI Code Detail

MEDICARE: CONNIE ANN GRICE

MEDICARE:   CONNIE ANN GRICE
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
1103K00000XBehavior Analyst
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1386988996
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNIE ANN GRICE
Provider Business Mailing Address
First Line : 2210 N ELDORADO AVE
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-6418
Country : US
Telephone Number : 541-883-1030
Fax Number : 541-884-2338
Provider Business Practice Location Address
First Line : 2210 N ELDORADO AVE
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-6418
Country : US
Telephone Number : 541-883-1030
Fax Number : 541-884-2338
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2012
Last Update Date : 03/11/2026

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Directions to “ CONNIE ANN GRICE ” Practice Location

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