Basic Information
| Provider Information | |||||||||
| NPI: | 1790166700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONAWAY | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 526 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ELBURN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601199129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143096933 | ||||||||
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| Practice Location | |||||||||
| Address1: | 452 N EOLA RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605029612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309990401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2015 | ||||||||
| LastUpdateDate: | 06/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-10-6871 | IL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.