Provider Demographics
NPI:1790538239
Name:CONWAY, MARIE C (BCBA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:C
Last Name:CONWAY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S MARYVILLE ST
Mailing Address - Street 2:
Mailing Address - City:CALMAR
Mailing Address - State:IA
Mailing Address - Zip Code:52132-8518
Mailing Address - Country:US
Mailing Address - Phone:563-880-8537
Mailing Address - Fax:
Practice Address - Street 1:305 S MARYVILLE ST
Practice Address - Street 2:
Practice Address - City:CALMAR
Practice Address - State:IA
Practice Address - Zip Code:52132-8518
Practice Address - Country:US
Practice Address - Phone:563-880-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123049103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst