Provider Demographics
NPI:1376022467
Name:BOULES, BARBARA CASE (RDN, CHC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:CASE
Last Name:BOULES
Suffix:
Gender:F
Credentials:RDN, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 PARK AVENUE
Mailing Address - Street 2:APT. 202
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514
Mailing Address - Country:US
Mailing Address - Phone:312-607-6689
Mailing Address - Fax:
Practice Address - Street 1:229 PARK AVENUE
Practice Address - Street 2:APT. 202
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514
Practice Address - Country:US
Practice Address - Phone:312-607-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006948133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered