Individual
TAJUAN CONWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
2422 N GRANDVIEW BLVD, WAUKESHA, WI 53188-6105
(262) 549-6600
Mailing address
4647 N 70TH ST, MILWAUKEE, WI 53218-4848
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17256-130
WI
Other
Enumeration date
04/30/2015
Last updated
12/01/2017
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