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General NPI Number Information
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NPI Number | 1700776747
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Entity Type | Individual
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Provider Name | TIFFANY CONNERS
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Gender | Female
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 631 N CARROLL PKWY APT 209
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City | GLENWOOD
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State | IL
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Zip | 60425-1161
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Country | US
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Telephone | 708-637-6760
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Fax |
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Provider Business Mailing Address
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Address Line | 11414 S WESTERN AVE APT 3C
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City | CHICAGO
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State | IL
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Zip | 60643-4170
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Country | US
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Telephone | 773-550-1313
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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