Healthcare Provider Details

I. General information

NPI: 1831490143
Provider Name (Legal Business Name): JANE CONWAY M.S, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S1597 HANSON RD
WESTBY WI
54667-8396
US

IV. Provider business mailing address

6824 SCHROEDER RD 13
MADISON WI
53711-6178
US

V. Phone/Fax

Practice location:
  • Phone: 608-634-2574
  • Fax:
Mailing address:
  • Phone: 608-575-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4172-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: