Provider Demographics
NPI:1417454026
Name:DENGLER-BROCKWAY, CONNIE LUISE (LSW)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:LUISE
Last Name:DENGLER-BROCKWAY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9895 COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9543
Mailing Address - Country:US
Mailing Address - Phone:513-515-4025
Mailing Address - Fax:
Practice Address - Street 1:9895 COVENTRY CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9543
Practice Address - Country:US
Practice Address - Phone:513-515-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1500595104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker