Individual
MARTHA LIECHTY CONRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.W.
Contact information
Practice address
1400 HUDSON ST, ELKHART, IN 46516-2023
(574) 522-0104
Mailing address
704 E KERCHER RD, GOSHEN, IN 46526-5325
(574) 533-3633
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
33000041A
IN
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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