Individual
VIRGINIA LEA CONNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD
Contact information
Practice address
141 S MCCORMICK ST STE 109, PRESCOTT, AZ 86303
(928) 710-8800
(928) 777-8020
Mailing address
141 S MCCORMICK ST STE 109, PRESCOTT, AZ 86303-4730
(928) 710-8800
(928) 777-8020
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
1004
AZ
103T00000X
Psychologist
1004
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
860969406
FEDERAL ID NUMBER
AZ
Enumeration date
04/10/2007
Last updated
06/27/2018
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