Healthcare Provider Details

I. General information

NPI: 1316722440
Provider Name (Legal Business Name): SARA OBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 PINTAIL DR
SPRINGFIELD IL
62711-6738
US

IV. Provider business mailing address

3921 PINTAIL DR
SPRINGFIELD IL
62711-6738
US

V. Phone/Fax

Practice location:
  • Phone: 217-572-2286
  • Fax:
Mailing address:
  • Phone: 217-572-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA1-25-84491
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: