Healthcare Provider Details

I. General information

NPI: 1619534815
Provider Name (Legal Business Name): EMMA JUNE CONWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MONROE ST
TOLEDO OH
43623-3462
US

IV. Provider business mailing address

5151 MONROE ST
TOLEDO OH
43623-3462
US

V. Phone/Fax

Practice location:
  • Phone: 419-574-9290
  • Fax:
Mailing address:
  • Phone: 419-574-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberUK838719
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: