Provider Demographics
NPI:1134362759
Name:BARRETT, SUE ANN (PHD, PMHNP)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANN
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PHD, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3033 OGDEN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1673
Mailing Address - Country:US
Mailing Address - Phone:630-357-4608
Mailing Address - Fax:630-357-4677
Practice Address - Street 1:3033 OGDEN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1673
Practice Address - Country:US
Practice Address - Phone:630-357-4608
Practice Address - Fax:630-357-4677
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005223363LP0808X
IL309002554363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health