Provider Demographics
NPI:1770337891
Name:CONLAN, AMY M
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:CONLAN
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 1:100 MADDUX CT APT F4
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5339
Mailing Address - Country:US
Mailing Address - Phone:931-209-7530
Mailing Address - Fax:
Practice Address - Street 1:206 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4748
Practice Address - Country:US
Practice Address - Phone:931-283-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician