Provider Demographics
NPI:1972844298
Name:NORTH, CONNIE E (PHD, MS)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:E
Last Name:NORTH
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 WILLIAMSON ST
Mailing Address - Street 2:204
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4810
Mailing Address - Country:US
Mailing Address - Phone:303-910-8507
Mailing Address - Fax:
Practice Address - Street 1:2453 ATWOOD AVE
Practice Address - Street 2:STE. 101B
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5661
Practice Address - Country:US
Practice Address - Phone:303-910-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI450470106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist