Provider Demographics
NPI:1700964673
Name:SIMONS, CONNIE LEE (PSYD RN)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:LEE
Last Name:SIMONS
Suffix:
Gender:F
Credentials:PSYD RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:241 GOLF MILL CENTER
Mailing Address - Street 2:#602
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-390-0776
Mailing Address - Fax:847-390-7625
Practice Address - Street 1:241 GOLF MILL CENTER
Practice Address - Street 2:#602
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-390-0776
Practice Address - Fax:847-390-7625
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL071006844103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364467571Medicaid