Provider Demographics
NPI:1366758617
Name:OBERG, CHRISTIE GOSS
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:GOSS
Last Name:OBERG
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 1:25 EASTERN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1168
Mailing Address - Country:US
Mailing Address - Phone:207-686-3015
Mailing Address - Fax:
Practice Address - Street 1:25 EASTERN RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1168
Practice Address - Country:US
Practice Address - Phone:207-686-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist