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General NPI Number Information
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NPI Number | 1407382294
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Entity Type | Individual
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Provider Name | PRAIRIE CONLON
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 2822 RIDLEY RD
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City | HARTLAND
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State | WI
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Zip | 53029-8835
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Country | US
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Telephone | 913-375-4934
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Fax |
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Provider Business Mailing Address
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Address Line | 2822 RIDLEY RD
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City | HARTLAND
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State | WI
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Zip | 53029-8835
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Country | US
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Telephone | 913-375-4934
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A12370
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC.0014978
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6369
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License Number State | OK
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