Provider Demographics
NPI:1750988010
Name:KONZEM, CONNIE SUE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:KONZEM
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 1:1816 POLK ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-7517
Mailing Address - Country:US
Mailing Address - Phone:620-282-1180
Mailing Address - Fax:
Practice Address - Street 1:809 S PATTON RD
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4620
Practice Address - Country:US
Practice Address - Phone:620-796-2206
Practice Address - Fax:866-288-1782
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)