Provider Demographics
NPI:1629085246
Name:EASTERDAY, BARBARA E (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:E
Last Name:EASTERDAY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 U.S.HWY.14
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012
Mailing Address - Country:US
Mailing Address - Phone:815-861-8258
Mailing Address - Fax:815-337-4470
Practice Address - Street 1:8600 U.S.HWY.14
Practice Address - Street 2:SUITE 501
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012
Practice Address - Country:US
Practice Address - Phone:815-861-8258
Practice Address - Fax:815-337-4470
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149009263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK07883Medicare ID - Type Unspecified