Provider Demographics
NPI:1619459260
Name:MCCONNELL, SUE (APSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:MCCONNELL
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:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53191-0934
Mailing Address - Country:US
Mailing Address - Phone:262-607-6387
Mailing Address - Fax:
Practice Address - Street 1:93 W GENEVA ST STE 934
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-9562
Practice Address - Country:US
Practice Address - Phone:262-607-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131200-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker