Provider Demographics
NPI:1891305504
Name:MCCONNELL, CONSTANCE (LCSW)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FLINT ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2901
Mailing Address - Country:US
Mailing Address - Phone:217-638-8892
Mailing Address - Fax:
Practice Address - Street 1:1955 BROADWAY
Practice Address - Street 2:104
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713
Practice Address - Country:US
Practice Address - Phone:217-638-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0177341041C0700X
WI87631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical