Provider Demographics
NPI:1689729071
Name:SILAS, BRIANNE (HIGH SCHOOL DIPLOMA)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:SILAS
Suffix:
Gender:F
Credentials:HIGH SCHOOL DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MELROSE VILLAGE CIR
Mailing Address - Street 2:APARTMENT 721 D
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-0960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 W PARK AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3929
Practice Address - Country:US
Practice Address - Phone:217-398-8080
Practice Address - Fax:217-398-8172
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor