Provider Demographics
NPI:1750530531
Name:CONWAY, KATHRYN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARIE
Last Name:CONWAY
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W 104TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1006
Mailing Address - Country:US
Mailing Address - Phone:773-507-0609
Mailing Address - Fax:
Practice Address - Street 1:2401 W 104TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1006
Practice Address - Country:US
Practice Address - Phone:773-507-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007500103TC2200X
IL071.007500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent