Provider Demographics
NPI:1497555767
Name:CONKLIN, AUSTUB
Entity type:Individual
Prefix:
First Name:AUSTUB
Middle Name:
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-9430
Mailing Address - Country:US
Mailing Address - Phone:740-861-0871
Mailing Address - Fax:740-861-0871
Practice Address - Street 1:208 4TH ST E
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-9430
Practice Address - Country:US
Practice Address - Phone:740-861-0871
Practice Address - Fax:740-861-0871
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator