Healthcare Provider Details

I. General information

NPI: 1902899131
Provider Name (Legal Business Name): LINDA CONAWAY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 NE VANCOUVER MALL DRIVE SUITE 203
VANCOUVER WA
98662
US

IV. Provider business mailing address

PO BOX 134
BATTLE GROUND WA
98604-0134
US

V. Phone/Fax

Practice location:
  • Phone: 360-694-4662
  • Fax:
Mailing address:
  • Phone: 360-694-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1024
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00001024
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: