Provider Demographics
NPI:1841935087
Name:CONKLIN, CARRIE RENEE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:RENEE
Last Name:CONKLIN
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 1:14805 SE BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-6541
Mailing Address - Country:US
Mailing Address - Phone:503-998-7055
Mailing Address - Fax:
Practice Address - Street 1:14805 SE BLUFF RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-6541
Practice Address - Country:US
Practice Address - Phone:503-998-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health