Provider Demographics
NPI:1336947209
Name:CONNER, JERRIE
Entity type:Individual
Prefix:
First Name:JERRIE
Middle Name:
Last Name:CONNER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4462
Mailing Address - Country:US
Mailing Address - Phone:419-787-3954
Mailing Address - Fax:
Practice Address - Street 1:2278 ROSEDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4462
Practice Address - Country:US
Practice Address - Phone:419-787-3954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator