Healthcare Provider Details

I. General information

NPI: 1932030798
Provider Name (Legal Business Name): ELIZABETH ANNE CONWAY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5416 EVERYBODYS RD
CRANDON WI
54520-8627
US

IV. Provider business mailing address

7467 CHARLIE SAMZ LN
ARGONNE WI
54511-9142
US

V. Phone/Fax

Practice location:
  • Phone: 715-478-7260
  • Fax:
Mailing address:
  • Phone: 715-889-9423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number135651-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: