Provider Demographics
NPI:1902899131
Name:CONAWAY, LINDA (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CONAWAY
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:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-0134
Mailing Address - Country:US
Mailing Address - Phone:360-694-4662
Mailing Address - Fax:
Practice Address - Street 1:9330 NE VANCOUVER MALL DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662
Practice Address - Country:US
Practice Address - Phone:360-694-4662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1024103G00000X
WAPY00001024103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8939878OtherCRIME VICTIMS
WA0193080OtherLABOR & IND.
OR022931Medicaid
WA8414153Medicaid
WA0193080OtherLABOR & IND.
WA0193080OtherLABOR & IND.