Provider Demographics
NPI:1336029651
Name:MANAR, TRISTA (MSW, PEL)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:MANAR
Suffix:
Gender:F
Credentials:MSW, PEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62014-1535
Mailing Address - Country:US
Mailing Address - Phone:618-585-4831
Mailing Address - Fax:
Practice Address - Street 1:700 W ORANGE ST
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:IL
Practice Address - Zip Code:62014-1535
Practice Address - Country:US
Practice Address - Phone:618-585-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool