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Contact Information

CONNIE J ALSUP, CRADAC
301 WARRIOR LANE
POPLAR BLUFF, MO63902
 Phone: 573-686-1200
 Fax: 573-686-1029
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction (Substance Use Disorder)

101YA0400X
Indicates primary specialty

NPI Profile & details for CONNIE J ALSUP · (Female)

NPI Number 1174812275
Status Active
Credentials CRADAC
Entity Individual
Enumeration date 03/30/2011
Last updated 03/30/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 4835
  • MO License # 920
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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