Provider Demographics
NPI:1780749382
Name:BARBOUR, BLAIR WINN (MSW ACSW LCSW)
Entity type:Individual
Prefix:MS
First Name:BLAIR
Middle Name:WINN
Last Name:BARBOUR
Suffix:
Gender:F
Credentials:MSW ACSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 LAKE STREET
Mailing Address - Street 2:SUITE 516
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1414
Mailing Address - Country:US
Mailing Address - Phone:708-386-1907
Mailing Address - Fax:708-848-3031
Practice Address - Street 1:715 LAKE STREET
Practice Address - Street 2:SUITE 516
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1414
Practice Address - Country:US
Practice Address - Phone:708-386-1907
Practice Address - Fax:708-848-3031
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL92906Medicare ID - Type Unspecified