| Doctor Name: | MS. CHERYL DENISE BRISTOR |
| NPI Number: | 1518974302 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW, CADC |
| License Number: | 13907 |
| Business Practice Address: | 3637 W 125th St Alsip, IL - 608031082 |
| Business Phone Number: | 7088241446 |
| Business Fax Number: | 7088241446 |
| Mailing Address: | Po Box 587782, ALSIP |
| State: | IL |
| Postal Code: | 608037782 |
| Phone Number: | 7088241446 |
| Fax Number: | 7088241446 |
| NPI Enumeration Date: | 08/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | 13907 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |