Provider Demographics
NPI:1124199138
Name:CONAWAY, PATRICK KELLY (MA CCC-A)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:KELLY
Last Name:CONAWAY
Suffix:
Gender:M
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 W. JARVIS AVENUE
Mailing Address - Street 2:1-SOUTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626
Mailing Address - Country:US
Mailing Address - Phone:773-880-3859
Mailing Address - Fax:
Practice Address - Street 1:1232 W JARVIS AVE
Practice Address - Street 2:1-SOUTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2026
Practice Address - Country:US
Practice Address - Phone:773-880-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist