1164062493 NPI number — MRS. ANNEMARIE CATHERINE BARTER BCBA

Table of content: MRS. ANNEMARIE CATHERINE BARTER BCBA (NPI 1164062493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164062493 NPI number — MRS. ANNEMARIE CATHERINE BARTER BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTER
Provider First Name:
ANNEMARIE
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LADING
Provider Other First Name:
ANNEMARIE
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164062493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 S. MILWAUKEE AVE
Provider Second Line Business Mailing Address:
SUITE 235
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-465-9556
Provider Business Mailing Address Fax Number:
847-465-9621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 S. MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
SUITE 235
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-465-9556
Provider Business Practice Location Address Fax Number:
847-465-9621
Provider Enumeration Date:
01/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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