Provider Demographics
NPI:1619467446
Name:CONRAD, MARCI A (CDCA)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:A
Last Name:CONRAD
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11424 COUNTY ROAD 1 APT 2
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-8209
Mailing Address - Country:US
Mailing Address - Phone:740-550-5686
Mailing Address - Fax:
Practice Address - Street 1:609 3RD AVE REAR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-1038
Practice Address - Country:US
Practice Address - Phone:740-451-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.172850171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0341499Medicaid