Healthcare Provider Details

I. General information

NPI: 1043814619
Provider Name (Legal Business Name): JANE ELIZABETH CONROY DEHEER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE ELIZABETH CONROY

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 N ELSTON AVE
CHICAGO IL
60642-1544
US

IV. Provider business mailing address

3730 N ASHLAND AVE UNIT 1
CHICAGO IL
60613-3602
US

V. Phone/Fax

Practice location:
  • Phone: 720-287-4185
  • Fax:
Mailing address:
  • Phone: 216-337-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number445857
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: