Provider Demographics
NPI:1982427795
Name:CONNER, SHAUNDRA CHRISTINE OPIE
Entity type:Individual
Prefix:
First Name:SHAUNDRA
Middle Name:CHRISTINE OPIE
Last Name:CONNER
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 1:227 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:IA
Mailing Address - Zip Code:51577-3011
Mailing Address - Country:US
Mailing Address - Phone:573-434-1850
Mailing Address - Fax:
Practice Address - Street 1:11 S 1ST ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4315
Practice Address - Country:US
Practice Address - Phone:515-967-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IABA-01109103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst