Provider Demographics
NPI:1366246647
Name:BRISTER, CYNTHIA B (LSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:B
Last Name:BRISTER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 W JACKSON BLVD # 1042
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2914
Mailing Address - Country:US
Mailing Address - Phone:888-994-7098
Mailing Address - Fax:
Practice Address - Street 1:1016 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2914
Practice Address - Country:US
Practice Address - Phone:888-994-7098
Practice Address - Fax:888-719-2771
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.115974104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker