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General NPI Number Information
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NPI Number | 1194043430
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Entity Type | Individual
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Provider Name | ANN BYSTEDT LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 550 W FRONTAGE RD
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City | NORTHFIELD
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State | IL
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Zip | 60093-1202
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Country | US
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Telephone | 773-908-1224
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Fax |
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Provider Business Mailing Address
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Address Line | 3707 N HARDING AVE
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City | CHICAGO
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State | IL
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Zip | 60618-4026
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Country | US
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Telephone | 773-478-0731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149010793
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License Number State | IL
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