Provider Demographics
NPI:1780217083
Name:O'BRIEN, MAEGAN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 CANDLEWICK DR NW
Mailing Address - Street 2:
Mailing Address - City:POPLAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61065-8999
Mailing Address - Country:US
Mailing Address - Phone:630-450-2622
Mailing Address - Fax:
Practice Address - Street 1:1237 CANDLEWICK DR NW
Practice Address - Street 2:
Practice Address - City:POPLAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:61065-8999
Practice Address - Country:US
Practice Address - Phone:630-450-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist