MEDICARE: BRYANT KEITH WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1770240350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYANT KEITH WILLIAMS

Provider Business Mailing Address
First Line	:	10013 GRAND AVE
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-2546
Country	:	US
Telephone Number	:	847-681-7704
Fax Number	:

Provider Business Practice Location Address
First Line	:	10013 GRAND AVE
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-2546
Country	:	US
Telephone Number	:	847-681-7704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	11/18/2021

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Directions to “ BRYANT KEITH WILLIAMS ” Practice Location

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