Provider Demographics
NPI:1235693094
Name:OFIARA, MAUREEN H
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:H
Last Name:OFIARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N HUDSON AVE UNIT 1010
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6701
Mailing Address - Country:US
Mailing Address - Phone:847-494-1598
Mailing Address - Fax:
Practice Address - Street 1:750 N HUDSON AVE UNIT 1010
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6701
Practice Address - Country:US
Practice Address - Phone:847-494-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14097917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist