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NPI Code Detail

MEDICARE: MS. KATHLEEN H. CULLEN-CONWAY LCSW, MSW

MEDICARE:  MS. KATHLEEN H. CULLEN-CONWAY  LCSW, MSW
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
1104100000XSocial WorkerIL

General Provider Information

NPI Number : 1487629747
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHLEEN H. CULLEN-CONWAY LCSW, MSW
Provider Business Mailing Address
First Line : 5428 N LUDLAM AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-1414
Country : US
Telephone Number : 773-286-8527
Fax Number :
Provider Business Practice Location Address
First Line : 444 N NORTHWEST HWY
Second Line : 145
City : PARK RIDGE
State : IL
Zip : 60068-3263
Country : US
Telephone Number : 847-685-6381
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 07/08/2007

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Directions to “ MS. KATHLEEN H. CULLEN-CONWAY LCSW, MSW” Practice Location

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