Provider Demographics
NPI:1013668417
Name:WILLIAMS, BRYANN MARIE (MSW/LSW)
Entity Type:Individual
Prefix:
First Name:BRYANN
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW/LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-5424
Mailing Address - Country:US
Mailing Address - Phone:815-719-2199
Mailing Address - Fax:
Practice Address - Street 1:396 BELLE AIRE AVE
Practice Address - Street 2:N/A
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2010
Practice Address - Country:US
Practice Address - Phone:815-939-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150106568104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker