Provider Demographics
NPI:1265847834
Name:BARA, KIRSTEN (ED M)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:BARA
Suffix:
Gender:F
Credentials:ED M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 RIVER RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2400
Mailing Address - Country:US
Mailing Address - Phone:630-209-8325
Mailing Address - Fax:
Practice Address - Street 1:1839 RIVER RIDGE CIR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2400
Practice Address - Country:US
Practice Address - Phone:630-209-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist