Provider Demographics
NPI:1033310297
Name:CONNOR, RAELYN JEANETTE (MED, PCC-S)
Entity Type:Individual
Prefix:MRS
First Name:RAELYN
Middle Name:JEANETTE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MED, PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2363
Mailing Address - Country:US
Mailing Address - Phone:740-996-7100
Mailing Address - Fax:740-346-0236
Practice Address - Street 1:3200 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2363
Practice Address - Country:US
Practice Address - Phone:740-996-7100
Practice Address - Fax:740-346-0236
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0007807.SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH24-01Medicaid
OH9149762Medicare ID - Type UnspecifiedMEDICARE