MEDICARE: CONNOR RICHARD MEERS LICSW

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1053196113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNOR RICHARD MEERS LICSW

Provider Business Mailing Address
First Line	:	1180 CALIFORNIA DR APT 103
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-2208
Country	:	US
Telephone Number	:	320-249-5624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 CALIFORNIA DR APT 103
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-2208
Country	:	US
Telephone Number	:	320-249-5624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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