Provider Demographics
NPI:1043270333
Name:CONNER, JUDITH (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 5427
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-5427
Mailing Address - Country:US
Mailing Address - Phone:712-274-6729
Mailing Address - Fax:712-274-6744
Practice Address - Street 1:3549 SOUTHERN HILLS DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4736
Practice Address - Country:US
Practice Address - Phone:712-274-6729
Practice Address - Fax:712-274-6744
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0157206Medicaid
R02850Medicare UPIN
IA47270Medicare ID - Type Unspecified