Provider Demographics
NPI:1164936506
Name:CONNOR, SHAWNDA K (PLADC)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNDA
Middle Name:K
Last Name:CONNOR
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 FLACK AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2722
Mailing Address - Country:US
Mailing Address - Phone:308-762-2723
Mailing Address - Fax:308-217-4277
Practice Address - Street 1:815 FLACK AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2722
Practice Address - Country:US
Practice Address - Phone:308-762-2723
Practice Address - Fax:308-217-4277
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1559101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)