Provider Demographics
NPI:1811073034
Name:DYANN INC
Entity type:Organization
Organization Name:DYANN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER PRE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DYANN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOCKSTAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:708-481-4098
Mailing Address - Street 1:3624 W 216TH STREET
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2713
Mailing Address - Country:US
Mailing Address - Phone:708-481-4080
Mailing Address - Fax:708-481-7725
Practice Address - Street 1:3624 W 216TH STREET
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2713
Practice Address - Country:US
Practice Address - Phone:708-481-4080
Practice Address - Fax:708-481-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)