MEDICARE: DYSTANIE A BRYANT

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	106S00000X	Behavior Technician	RBT-25-503874	IL

General Provider Information

NPI Number	:	1972453181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYSTANIE A BRYANT

Provider Business Mailing Address
First Line	:	2933 141ST PL
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-3313
Country	:	US
Telephone Number	:	708-470-2370
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 S MICHIGAN AVE STE 900
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-4393
Country	:	US
Telephone Number	:	815-395-1073
Fax Number	:

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

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “ DYSTANIE A BRYANT ” Practice Location

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