Provider Demographics
NPI:1235978792
Name:CRIQUI, CONNIE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:CRIQUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 E 261 ST
Mailing Address - Street 2:
Mailing Address - City:LYNDON
Mailing Address - State:KS
Mailing Address - Zip Code:66451
Mailing Address - Country:US
Mailing Address - Phone:785-640-3552
Mailing Address - Fax:
Practice Address - Street 1:3500 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2814
Practice Address - Country:US
Practice Address - Phone:785-640-3552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional