Provider Demographics
NPI:1205353323
Name:VINES, BARBARA H (MS)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:H
Last Name:VINES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHWEST SPECIAL EDUCATION COOP
Mailing Address - Street 2:310 WEST STREET
Mailing Address - City:ELIZABETH
Mailing Address - State:IL
Mailing Address - Zip Code:61028
Mailing Address - Country:US
Mailing Address - Phone:815-599-1947
Mailing Address - Fax:
Practice Address - Street 1:100 S SUMMIT ST
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:IL
Practice Address - Zip Code:61062-8816
Practice Address - Country:US
Practice Address - Phone:815-443-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1826603103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool