Provider Demographics
NPI:1407382294
Name:CONLON, PRAIRIE
Entity Type:Individual
Prefix:
First Name:PRAIRIE
Middle Name:
Last Name:CONLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 RIDLEY RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-8835
Mailing Address - Country:US
Mailing Address - Phone:913-375-4934
Mailing Address - Fax:
Practice Address - Street 1:2822 RIDLEY RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-8835
Practice Address - Country:US
Practice Address - Phone:913-375-4934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12370101YP2500X
COLPCC.0014978101YP2500X
OK6369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional