Provider Demographics
NPI:1760514657
Name:BARKER, ROBERTA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:ANN
Last Name:BARKER
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 1:2604 DEMPSTER ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-699-1306
Mailing Address - Fax:847-299-1521
Practice Address - Street 1:2604 DEMPSTER ST
Practice Address - Street 2:SUITE 308
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-699-1306
Practice Address - Fax:847-299-1521
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01672647OtherBLUE SHIELD PROVIDER #
IL675060Medicare ID - Type UnspecifiedPROVIDER #