Individual
HOLLY LYN CONKLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDC-A, CIP
Contact information
Practice address
123 S WASHINGTON ST, VAN WERT, OH 45891-1707
(918) 500-2570
(419) 771-1051
Mailing address
123 S WASHINGTON ST, VAN WERT, OH 45891-1707
(918) 500-2570
(419) 771-1051
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.169820
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427664
—
OH
Enumeration date
04/25/2019
Last updated
07/25/2022
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