Healthcare Provider Details

I. General information

NPI: 1164193876
Provider Name (Legal Business Name): JARED ELWART LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 FRANKLIN ST
DOWNERS GROVE IL
60515-3551
US

IV. Provider business mailing address

106 S LINCOLNWAY STE F
NORTH AURORA IL
60542-1597
US

V. Phone/Fax

Practice location:
  • Phone: 630-437-1999
  • Fax:
Mailing address:
  • Phone: 630-801-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149.025584
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: