Healthcare Provider Details

I. General information

NPI: 1780703462
Provider Name (Legal Business Name): RICHARD JOHN CONNOR M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 44TH ST
ROCK ISLAND IL
61201-7187
US

IV. Provider business mailing address

4709 44TH ST
ROCK ISLAND IL
61201-7187
US

V. Phone/Fax

Practice location:
  • Phone: 309-793-3460
  • Fax: 309-732-0551
Mailing address:
  • Phone: 309-793-3460
  • Fax: 309-732-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: