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NPI Code Detail

MEDICARE: BRIANNA REGINE BYRD

MEDICARE:   BRIANNA REGINE BYRD
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1841037694
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANNA REGINE BYRD
Provider Business Mailing Address
First Line : 1579 WENTWORTH AVE
Second Line :
City : CALUMET CITY
State : IL
Zip : 60409-6325
Country : US
Telephone Number : 773-242-3360
Fax Number :
Provider Business Practice Location Address
First Line : 1579 WENTWORTH AVE
Second Line :
City : CALUMET CITY
State : IL
Zip : 60409-6325
Country : US
Telephone Number : 773-242-3360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2024
Last Update Date : 07/26/2024

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Directions to “ BRIANNA REGINE BYRD ” Practice Location

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