Provider Demographics
NPI:1710315973
Name:BARR, DESIREE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 N LINCOLN AVE APT 312
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3177
Mailing Address - Country:US
Mailing Address - Phone:618-559-7305
Mailing Address - Fax:
Practice Address - Street 1:3151 N LINCOLN AVE APT 312
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3177
Practice Address - Country:US
Practice Address - Phone:618-559-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist