Provider Demographics
NPI:1518451897
Name:OAKLEY, MARIAH ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:ANNE
Last Name:OAKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 N PERRYVILLE RD # 1110
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6814
Mailing Address - Country:US
Mailing Address - Phone:815-469-1500
Mailing Address - Fax:779-220-2189
Practice Address - Street 1:2990 N PERRYVILLE RD # 1110
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6814
Practice Address - Country:US
Practice Address - Phone:815-469-1500
Practice Address - Fax:779-220-2189
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0260521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty