Provider Demographics
NPI:1801293543
Name:CONN, CHRIS (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:CONN
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-2940
Mailing Address - Country:US
Mailing Address - Phone:812-282-3676
Mailing Address - Fax:812-282-3697
Practice Address - Street 1:1516 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-2940
Practice Address - Country:US
Practice Address - Phone:812-282-3676
Practice Address - Fax:812-282-3697
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17000968A237700000X
KYKY-0635237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist