Provider Demographics
NPI:1629499777
Name:BARRETT, TED A
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:A
Last Name:BARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6N027 WHEATON RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3318
Mailing Address - Country:US
Mailing Address - Phone:312-884-1537
Mailing Address - Fax:
Practice Address - Street 1:6N027 WHEATON RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-3318
Practice Address - Country:US
Practice Address - Phone:312-884-1537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst