Provider Demographics
NPI:1053003624
Name:BARKENQUAST, LAURA RUTH (DSP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:RUTH
Last Name:BARKENQUAST
Suffix:
Gender:F
Credentials:DSP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:RUTH
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSP
Mailing Address - Street 1:7213 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1264
Mailing Address - Country:US
Mailing Address - Phone:708-657-4126
Mailing Address - Fax:
Practice Address - Street 1:6639 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4161
Practice Address - Country:US
Practice Address - Phone:773-765-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health