Provider Demographics
NPI:1063899722
Name:CONWAY, ERIN (PSYD, CADC, BCB, BCN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PSYD, CADC, BCB, BCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S RAND RD STE 214
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2307
Mailing Address - Country:US
Mailing Address - Phone:224-723-0378
Mailing Address - Fax:
Practice Address - Street 1:1701 E WOODFIELD ROAD
Practice Address - Street 2:SUITE 1000
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5113
Practice Address - Country:US
Practice Address - Phone:847-240-2211
Practice Address - Fax:847-240-2418
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207844OtherGROUP MEDICARE