Provider Demographics
NPI:1386302362
Name:BARRETT, STEPHEN (EMT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:BARRETT
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 222ND ST
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-5046
Mailing Address - Country:US
Mailing Address - Phone:708-758-2225
Mailing Address - Fax:
Practice Address - Street 1:1804 222ND ST
Practice Address - Street 2:
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411-5046
Practice Address - Country:US
Practice Address - Phone:708-758-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL06200052146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8086Medicaid