Provider Demographics
NPI:1912484916
Name:MCCONICO, KANDYCE
Entity Type:Individual
Prefix:
First Name:KANDYCE
Middle Name:
Last Name:MCCONICO
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 1:2040 HEATHERWOOD DR APT 201
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2221
Mailing Address - Country:US
Mailing Address - Phone:224-944-2672
Mailing Address - Fax:
Practice Address - Street 1:2040 HEATHERWOOD DR APT 201
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2221
Practice Address - Country:US
Practice Address - Phone:224-944-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional