Provider Demographics
NPI:1487860805
Name:GRACE, BARBARA ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ROSE
Last Name:GRACE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 OLD BARN RD APT C
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6207
Mailing Address - Country:US
Mailing Address - Phone:847-381-1710
Mailing Address - Fax:
Practice Address - Street 1:THE GRACE CENTER, PC
Practice Address - Street 2:118 BARRINGTON COMMONS, SUITE 227
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-382-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL72-002799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical