Healthcare Provider Details

I. General information

NPI: 1023419348
Provider Name (Legal Business Name): LISA ANNETTE CONWAY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANNETTE PAUL PHD

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W INSTITUTE PL STE 500
CHICAGO IL
60610-8792
US

IV. Provider business mailing address

213 W INSTITUTE PL STE 500
CHICAGO IL
60610-8792
US

V. Phone/Fax

Practice location:
  • Phone: 312-471-3910
  • Fax:
Mailing address:
  • Phone: 312-471-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071.008678
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008678
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: