Provider Demographics
NPI:1164512265
Name:OBERG, DEBBIE ANN (LICSW, CDMS)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ANN
Last Name:OBERG
Suffix:
Gender:F
Credentials:LICSW, CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-3008
Mailing Address - Country:US
Mailing Address - Phone:701-795-3099
Mailing Address - Fax:
Practice Address - Street 1:3535 S 31ST ST STE 201
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3593
Practice Address - Country:US
Practice Address - Phone:701-780-6821
Practice Address - Fax:701-780-1973
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2977104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker