Provider Demographics
NPI:1932370228
Name:GOODE-BAARS, BARBARA LYNN (LMT,CIMI)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LYNN
Last Name:GOODE-BAARS
Suffix:
Gender:F
Credentials:LMT,CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7129 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5221
Mailing Address - Country:US
Mailing Address - Phone:262-496-4697
Mailing Address - Fax:
Practice Address - Street 1:6201 75TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3513
Practice Address - Country:US
Practice Address - Phone:262-496-4697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3689046225700000X
TXMT030236225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist