Provider Demographics
NPI:1952430258
Name:CONRON, JANE DOROTHY
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:DOROTHY
Last Name:CONRON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:DOROTHY
Other - Last Name:CONRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:6007 N SHERIDAN RD
Mailing Address - Street 2:#26E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3039
Mailing Address - Country:US
Mailing Address - Phone:773-293-3835
Mailing Address - Fax:
Practice Address - Street 1:122 S MICHIGAN AVE
Practice Address - Street 2:#1025
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6191
Practice Address - Country:US
Practice Address - Phone:773-859-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622678OtherBLUE CROSS BLUE SHIELD
IL203754Medicare ID - Type Unspecified