Provider Demographics
NPI:1396038485
Name:CONNER, WILLIAM EDWARD
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWARD
Last Name:CONNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16141 E. BURNSIDE STREET
Mailing Address - Street 2:ALLIED EAST
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233
Mailing Address - Country:US
Mailing Address - Phone:503-252-3949
Mailing Address - Fax:503-252-4027
Practice Address - Street 1:16141 E. BURNSIDE STREET
Practice Address - Street 2:ALLIED EAST
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233
Practice Address - Country:US
Practice Address - Phone:503-252-3949
Practice Address - Fax:503-252-4027
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)