Healthcare Provider Details

I. General information

NPI: 1689729071
Provider Name (Legal Business Name): BRIANNE SILAS HIGH SCHOOL DIPLOMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W PARK AVE
CHAMPAIGN IL
61820-3929
US

IV. Provider business mailing address

1701 MELROSE VILLAGE CIR APARTMENT 721 D
URBANA IL
61801-0960
US

V. Phone/Fax

Practice location:
  • Phone: 217-398-8080
  • Fax: 217-398-8172
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: