Healthcare Provider Details

I. General information

NPI: 1578427274
Provider Name (Legal Business Name): SARA ASHLEY CONWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W TERRA COTTA AVE STE A
CRYSTAL LAKE IL
60014-3552
US

IV. Provider business mailing address

330 W TERRA COTTA AVE
CRYSTAL LAKE IL
60014-3552
US

V. Phone/Fax

Practice location:
  • Phone: 815-382-9691
  • Fax:
Mailing address:
  • Phone: 815-382-9691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.030377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: