Provider Demographics
NPI:1780381178
Name:CONWAY, EMMA SHANNON (MSW, LGSW)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:SHANNON
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:MRS
Other - First Name:EMMA
Other - Middle Name:DENISE
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2789 ARONA ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3189
Mailing Address - Country:US
Mailing Address - Phone:651-269-4732
Mailing Address - Fax:
Practice Address - Street 1:310 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3218
Practice Address - Country:US
Practice Address - Phone:612-223-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29365104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker