Provider Demographics
NPI:1306638044
Name:TRAVIS, IRENE BARBARA
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:BARBARA
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17233 LAKEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-6087
Mailing Address - Country:US
Mailing Address - Phone:708-860-3986
Mailing Address - Fax:
Practice Address - Street 1:4212 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2935
Practice Address - Country:US
Practice Address - Phone:773-774-4444
Practice Address - Fax:773-774-4447
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker