Provider Demographics
NPI:1538183041
Name:CONRAD, MARLYS ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARLYS
Middle Name:ANN
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 MICHIGAN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1494
Mailing Address - Country:US
Mailing Address - Phone:847-733-8052
Mailing Address - Fax:847-733-8008
Practice Address - Street 1:3285 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1564
Practice Address - Country:US
Practice Address - Phone:847-577-1155
Practice Address - Fax:847-577-3858
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012964103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL67474Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST