Healthcare Provider Details

I. General information

NPI: 1316875198
Provider Name (Legal Business Name): MAREN JEAN CONWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6417 PENN AVE S STE 7-1493
MINNEAPOLIS MN
55423-1186
US

IV. Provider business mailing address

6417 PENN AVE S STE 7-1493
MINNEAPOLIS MN
55423-1186
US

V. Phone/Fax

Practice location:
  • Phone: 612-643-1828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberLP6378
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: