Provider Demographics
NPI:1588225270
Name:O'CONNOR, DEBORAH (APSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8036 N SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2968
Mailing Address - Country:US
Mailing Address - Phone:608-220-0887
Mailing Address - Fax:
Practice Address - Street 1:1655 W MEQUON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3254
Practice Address - Country:US
Practice Address - Phone:414-266-3339
Practice Address - Fax:262-240-9745
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128846-121104100000X
WI9693104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1588225270Medicaid