Provider Information for 1598253890
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CONNIE RAE CHAMPION LSW, LPC-IT, SAC-IT
Other Names:Former Name:CONNIE RAE GEESex: Female
NPI: 1598253890
Last Updated: 2018-04-23
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1598253890 | ||||||||||||
| Enumeration Date | 2018-04-23 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 5900 MONONA DR STE 300 MONONA, WI 53716-3561 United States Phone: 608-663-2120 | Fax: | ||||||||||||
| Primary Practice Address | 414 BROADWAY ST STE 101 BARABOO, WI 53913-2488 United States Phone: 608-402-4312 | Fax: | ||||||||||||
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