Provider Demographics
NPI:1760592067
Name:CONRAD, CAROL ANN III (EDD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:CONRAD
Suffix:III
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 W. QUINAULT AVE
Mailing Address - Street 2:SUITE F202
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-579-0200
Mailing Address - Fax:509-232-0216
Practice Address - Street 1:8121 W. QUINAULT AVE.
Practice Address - Street 2:SUITE F202
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-579-0200
Practice Address - Fax:509-232-0216
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health