Provider Demographics
NPI:1790038289
Name:CONAWAY, KELLIE BONHAM (LSW)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:BONHAM
Last Name:CONAWAY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-2207
Mailing Address - Country:US
Mailing Address - Phone:304-280-0699
Mailing Address - Fax:
Practice Address - Street 1:104 1/2 N MARIETTA ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1255
Practice Address - Country:US
Practice Address - Phone:744-069-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0800390104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker