Basic Information
| Provider Information | |||||||||
| NPI: | 1346957487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTTRUM | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4711 GOLF RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3124500767 | ||||||||
| FaxNumber: | 8476798340 | ||||||||
| Practice Location | |||||||||
| Address1: | 4711 GOLF RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3124500767 | ||||||||
| FaxNumber: | 8476798340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2022 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 071010828 | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.