Provider Demographics
NPI:1346957487
Name:BARTTRUM, TERESA (PSYD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BARTTRUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 GOLF RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1242
Mailing Address - Country:US
Mailing Address - Phone:312-450-0767
Mailing Address - Fax:847-679-8340
Practice Address - Street 1:4711 GOLF RD STE 400
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1242
Practice Address - Country:US
Practice Address - Phone:312-450-0767
Practice Address - Fax:847-679-8340
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical