Provider Demographics
NPI:1851544076
Name:CONNELL, KARA ANN
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ANN
Last Name:CONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 S COLLEGE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3002
Mailing Address - Country:US
Mailing Address - Phone:970-420-9684
Mailing Address - Fax:
Practice Address - Street 1:504 S COLLEGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3002
Practice Address - Country:US
Practice Address - Phone:970-420-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9929481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical