Provider Demographics
NPI:1518388784
Name:OBERWISE, GUY E (LCSW)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:E
Last Name:OBERWISE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12618 S MCVICKERS AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1833
Mailing Address - Country:US
Mailing Address - Phone:708-522-4815
Mailing Address - Fax:815-806-9595
Practice Address - Street 1:12 SALT CREEK LANE
Practice Address - Street 2:SUITE 405
Practice Address - City:HINSDALE
Practice Address - State:USA
Practice Address - Zip Code:60521
Practice Address - Country:UM
Practice Address - Phone:630-789-7800
Practice Address - Fax:630-789-7803
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0027601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical