| Doctor Name: | LISA ANNETTE CONWAY |
| NPI Number: | 1023419348 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 071008678 |
| Business Practice Address: | 830 W End Ct Suite 400 Vernon Hills, IL - 600611365 |
| Business Phone Number: | 8472476910 |
| Business Fax Number: | 8472476950 |
| Mailing Address: | Po Box 610, NORTH CHICAGO |
| State: | IL |
| Postal Code: | 600640610 |
| Phone Number: | 8475788767 |
| Fax Number: | 8475788671 |
| NPI Enumeration Date: | 09/05/2014 |
| NPI Last Update Date: | 04/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071008678 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |