Provider Demographics
NPI:1134886336
Name:TARTT, BRYANNA A
Entity type:Individual
Prefix:
First Name:BRYANNA
Middle Name:A
Last Name:TARTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 N HERMITAGE AVE APT 3H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5578
Mailing Address - Country:US
Mailing Address - Phone:773-726-7237
Mailing Address - Fax:
Practice Address - Street 1:300 W ADAMS ST STE 514
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5108
Practice Address - Country:US
Practice Address - Phone:312-724-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36656101YA0400X
IL1490242421041C0700X
IL150.103731101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical