Active NPI
Jane Ann Connon
- Counseling Psychologist
- Portage, MI
National Provider Identifier
1174147755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 6361006545
- Practice address
- 5619 Downing St
Portage, MI 49024-9519 - Phone
- (269) 484-4502
- NPI assigned
- May 30, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 6361006545 | MI | Primary |
Addresses
Primary practice location
5619 Downing St
Portage, MI 49024-9519
Mailing address
5619 Downing St
Portage, MI 49024-9519
Phone (269) 484-4502
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6361006545 | MI | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590796800000",
"number": "1174147755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5619 DOWNING ST",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490249519",
"telephone_number": "269-484-4502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5619 DOWNING ST",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490249519",
"telephone_number": "269-484-4502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNON",
"first_name": "JANE",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-30",
"last_updated": "2020-05-30",
"certification_date": "2020-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MI",
"license": "6361006545",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.