Provider Demographics
NPI:1356327738
Name:CONNORS, PATRICIA K (MA LCSW LMFT CADCIII)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:K
Last Name:CONNORS
Suffix:
Gender:F
Credentials:MA LCSW LMFT CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:615 S 8TH ST
Mailing Address - Street 2:STE G20
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4405
Mailing Address - Country:US
Mailing Address - Phone:920-457-8866
Mailing Address - Fax:920-457-8867
Practice Address - Street 1:615 S 8TH ST
Practice Address - Street 2:STE G20
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4405
Practice Address - Country:US
Practice Address - Phone:920-457-8866
Practice Address - Fax:920-457-8867
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI36851231041C0700X
WI12124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39306500Medicaid