Provider Demographics
NPI:1982453189
Name:PARDO, CONNER MADDOX
Entity type:Individual
Prefix:
First Name:CONNER
Middle Name:MADDOX
Last Name:PARDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6380 MARILEE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-8356
Mailing Address - Country:US
Mailing Address - Phone:719-304-9480
Mailing Address - Fax:
Practice Address - Street 1:1425 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2871
Practice Address - Country:US
Practice Address - Phone:719-304-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician