Provider Demographics
NPI:1447422936
Name:BARBARA A. HALLSTROM LLC
Entity Type:Organization
Organization Name:BARBARA A. HALLSTROM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:815-235-2353
Mailing Address - Street 1:5230 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-6618
Mailing Address - Country:US
Mailing Address - Phone:815-235-2353
Mailing Address - Fax:
Practice Address - Street 1:1011 LORAS DR STE C
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6900
Practice Address - Country:US
Practice Address - Phone:815-233-2524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8932014OtherBCBS OF ILLINOIS