Provider Demographics
NPI:1790945194
Name:CONNER, KRISTI MICHELE (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:MICHELE
Last Name:CONNER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 N 30TH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3352
Mailing Address - Country:US
Mailing Address - Phone:253-345-1862
Mailing Address - Fax:253-736-0128
Practice Address - Street 1:2209 N 30TH ST
Practice Address - Street 2:STE 1
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3352
Practice Address - Country:US
Practice Address - Phone:253-345-1862
Practice Address - Fax:253-736-0128
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WARC60017858101YP2500X
WALW 602256761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional