Provider Demographics
NPI:1104827005
Name:BIRD-OBERG, MAUREEN L (MDIV)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:L
Last Name:BIRD-OBERG
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 PIUTE TRL
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-7898
Mailing Address - Country:US
Mailing Address - Phone:708-205-6858
Mailing Address - Fax:708-429-2775
Practice Address - Street 1:8020 PIUTE TRL
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-7898
Practice Address - Country:US
Practice Address - Phone:708-205-6858
Practice Address - Fax:708-429-2775
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional