Provider Demographics
NPI:1215089073
Name:CONLEY, TIMOTHY F (NBC-HIS)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:F
Last Name:CONLEY
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 W RIVERSIDE BLVD
Mailing Address - Street 2:NORTH TOWNE MALL
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-2195
Mailing Address - Country:US
Mailing Address - Phone:815-877-8600
Mailing Address - Fax:815-877-0661
Practice Address - Street 1:1090 W RIVERSIDE BLVD
Practice Address - Street 2:NORTH TOWNE MALL
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-2195
Practice Address - Country:US
Practice Address - Phone:815-877-8600
Practice Address - Fax:815-877-0661
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0417237700000X
WI426-060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist