Provider Demographics
NPI:1417907387
Name:BARKER, CARINA LISA
Entity Type:Individual
Prefix:MS
First Name:CARINA
Middle Name:LISA
Last Name:BARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 EAST 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880
Mailing Address - Country:US
Mailing Address - Phone:218-212-3435
Mailing Address - Fax:218-234-2993
Practice Address - Street 1:2207 EAST 5TH STREET
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880
Practice Address - Country:US
Practice Address - Phone:218-212-3435
Practice Address - Fax:218-234-2993
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN153621041C0700X
AZ177851041C0700X
WI9527-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1417907387Medicaid
MN560685300Medicaid