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NPI Code Detail

MEDICARE: KATHLEEN CONRAD LCSW

MEDICARE: KATHLEEN CONRAD 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
11041C0700XClinical Social WorkerLCSW-11250AZ

Other Identifiers

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

General Provider Information

NPI Number : 1912944380
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN CONRAD LCSW
Provider Business Mailing Address
First Line : 131 VISTA BONITA DR
Second Line :
City : SEDONA
State : AZ
Zip : 86336-7013
Country : US
Telephone Number : 928-634-2236
Fax Number : 928-634-8960
Provider Business Practice Location Address
First Line : 8 E COTTONWOOD ST
Second Line :
City : COTTONWOOD
State : AZ
Zip : 86326-4382
Country : US
Telephone Number : 928-634-2236
Fax Number : 928-634-8960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 07/08/2007

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Directions to “ KATHLEEN CONRAD LCSW” Practice Location

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