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General NPI Number Information
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NPI Number | 1255571402
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Entity Type | Organization
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Legal Business Name | FAMILY CONNECTIONS, LLC
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Dates
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Enumeration Date | 03/01/2009
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Last Update Date | 03/01/2009
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Provider Practice Location Address
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Address Line | 909 N SMILEY ST
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City | O FALLON
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State | IL
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Zip | 62269-1231
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Country | US
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Telephone | 618-741-4123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 122
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City | O FALLON
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State | IL
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Zip | 62269-0122
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Country | US
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Telephone | 618-741-4123
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. WENDY SUE BECKER PHILLIPS
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Credential | LCSW
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Telephone | 618-741-4123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 002882
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | WP32261106P
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 1621340
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149006943
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License Number State | IL
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