Provider Demographics
NPI:1558666123
Name:CONNERS, SHANNON R
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:CONNERS
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 1:611 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1685
Mailing Address - Country:US
Mailing Address - Phone:317-362-5025
Mailing Address - Fax:
Practice Address - Street 1:611 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1685
Practice Address - Country:US
Practice Address - Phone:317-362-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst