Healthcare Provider Details

I. General information

NPI: 1912505033
Provider Name (Legal Business Name): MARGARET O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MANTENO IL
60950-9466
US

IV. Provider business mailing address

10214 S WOOD ST
CHICAGO IL
60643-2016
US

V. Phone/Fax

Practice location:
  • Phone: 815-468-6581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.016071
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: