Provider Demographics
NPI:1417513235
Name:CONWAY, JAMES MATTHEW
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:CONWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-3217
Mailing Address - Country:US
Mailing Address - Phone:541-740-5308
Mailing Address - Fax:990-868-6503
Practice Address - Street 1:5100 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-3217
Practice Address - Country:US
Practice Address - Phone:541-740-5308
Practice Address - Fax:990-868-6503
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker