Provider Demographics
NPI:1386842029
Name:PAULSBERG, CHRISTINA MARIA
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIA
Last Name:PAULSBERG
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 1:2749 MORAINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-5006
Mailing Address - Country:US
Mailing Address - Phone:847-962-1644
Mailing Address - Fax:
Practice Address - Street 1:2749 MORAINE VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-5006
Practice Address - Country:US
Practice Address - Phone:847-962-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist