Provider Demographics
NPI:1770731119
Name:OSWALD, GREGORY THOMAS (PSYD)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:THOMAS
Last Name:OSWALD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:24012 W RENWICK RD
Mailing Address - Street 2:UNIT 204A
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8731
Mailing Address - Country:US
Mailing Address - Phone:815-676-4688
Mailing Address - Fax:815-676-4498
Practice Address - Street 1:24012 W RENWICK RD
Practice Address - Street 2:UNIT 204A
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8731
Practice Address - Country:US
Practice Address - Phone:815-676-4688
Practice Address - Fax:815-676-4498
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL180.007747101YP2500X
IL071.007747103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional