Provider Demographics
NPI:1861414443
Name:OLIVER, VICKY D (LCSW)
Entity type:Individual
Prefix:MS
First Name:VICKY
Middle Name:D
Last Name:OLIVER
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 1:16860 OAK PARK AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2008
Mailing Address - Country:US
Mailing Address - Phone:798-283-8777
Mailing Address - Fax:708-283-8770
Practice Address - Street 1:16860 OAK PARK AVE
Practice Address - Street 2:STE 103
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2008
Practice Address - Country:US
Practice Address - Phone:219-836-8806
Practice Address - Fax:708-283-8770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001877A104100000X
IL141-002181104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN219780OtherMEDICARE
IN219780OtherMEDICARE