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NPI Code Detail

MEDICARE: MRS. KATHRYN RAE CONWAY

MEDICARE: MRS. KATHRYN RAE CONWAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLMSW-13446AZ

General Provider Information

NPI Number : 1457607970
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHRYN RAE CONWAY
Provider Business Mailing Address
First Line : 140 W SPEEDWAY BLVD
Second Line : SUITE 130
City : TUCSON
State : AZ
Zip : 85705-7686
Country : US
Telephone Number : 520-623-0344
Fax Number : 520-770-8578
Provider Business Practice Location Address
First Line : 140 W SPEEDWAY BLVD
Second Line : SUITE 130
City : TUCSON
State : AZ
Zip : 85705-7686
Country : US
Telephone Number : 520-623-0344
Fax Number : 520-770-8578
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2012
Last Update Date : 08/02/2012

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