Provider Demographics
NPI:1053107771
Name:BARKSDALE, BRANDON LAVELL
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LAVELL
Last Name:BARKSDALE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 W JARVIS AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-7061
Mailing Address - Country:US
Mailing Address - Phone:224-247-1746
Mailing Address - Fax:
Practice Address - Street 1:415 S KILPATRICK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4923
Practice Address - Country:US
Practice Address - Phone:773-854-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker