Provider Demographics
NPI:1366677130
Name:O'CONNER, KRISTIN (MHC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:O'CONNER
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1833
Mailing Address - Country:US
Mailing Address - Phone:641-236-6137
Mailing Address - Fax:641-236-0206
Practice Address - Street 1:200 4TH AVE W
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1833
Practice Address - Country:US
Practice Address - Phone:641-236-6137
Practice Address - Fax:641-236-0206
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAPENDING101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06946OtherWELLMARK BCBS OF IOWA
IA0069468Medicaid