Basic Information
| Provider Information | |||||||||
| NPI: | 1245265396 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAMER | ||||||||
| FirstName: | CONNIE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW, LCSW, BCD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 INDEPENDENCE | ||||||||
| Address2: | 14TH MEDICAL GROUP | ||||||||
| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397105300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624342273 | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 W LOSEY ST | ||||||||
| Address2: | |||||||||
| City: | SCOTT AFB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622255250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182295497 | ||||||||
| FaxNumber: | 6182567299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2003017032 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.