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NPI Code Detail

MEDICARE: JUSTICE CONN

MEDICARE: JUSTICE CONN
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1588374169
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTICE CONN
Provider Business Mailing Address
First Line : 2535 MILLIKIN PKWY
Second Line :
City : DECATUR
State : IL
Zip : 62526-2156
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2535 MILLIKIN PKWY
Second Line :
City : DECATUR
State : IL
Zip : 62526-2156
Country : US
Telephone Number : 217-843-0290
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2022
Last Update Date : 12/05/2022

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Directions to “ JUSTICE CONN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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