Provider Demographics
NPI:1346708815
Name:ERIN CONWAY, PSYD, SC
Entity type:Organization
Organization Name:ERIN CONWAY, PSYD, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:224-475-1223
Mailing Address - Street 1:444 S RAND RD STE 211
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:224-475-1223
Mailing Address - Fax:224-607-3302
Practice Address - Street 1:444 S RAND RD STE 211
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2307
Practice Address - Country:US
Practice Address - Phone:224-475-1223
Practice Address - Fax:224-607-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service