Provider Demographics
NPI:1114171006
Name:BRYANT, RUTH DUREE (MS)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:DUREE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CIVIC DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-1257
Mailing Address - Country:US
Mailing Address - Phone:847-524-1505
Mailing Address - Fax:847-524-2201
Practice Address - Street 1:217 CIVIC DR
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-1257
Practice Address - Country:US
Practice Address - Phone:847-524-1505
Practice Address - Fax:847-524-2201
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166-000223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist