MEDICARE: MR. LARRY SCOTT CONNER LCSW

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	2002019886	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619046034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY SCOTT CONNER LCSW

Provider Business Mailing Address
First Line	:	5326 SOUTH FORT
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810
Country	:	US
Telephone Number	:	417-818-2189
Fax Number	:

Provider Business Practice Location Address
First Line	:	LAKELAND REGIONAL HOSPITAL
Second Line	:	440 SOUTH MARKET
City	:	SPRINGFIELD
State	:	MO
Zip	:	65806-2026
Country	:	US
Telephone Number	:	417-865-5581
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	09/24/2013

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