Basic Information
Provider Information
NPI: 1790183994
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARAN HANKUS
FirstName: BERNADETA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 N COUNTY FARM RD
Address2:  
City: WHEATON
State: IL
PostalCode: 601873977
CountryCode: US
TelephoneNumber: 6306827400
FaxNumber:  
Practice Location
Address1: 111 N COUNTY FARM RD
Address2:  
City: WHEATON
State: IL
PostalCode: 601873977
CountryCode: US
TelephoneNumber: 6306827400
FaxNumber: 6306905282
Other Information
ProviderEnumerationDate: 12/21/2014
LastUpdateDate: 05/27/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174H00000X  N Other Service ProvidersHealth Educator 
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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