Healthcare Provider Details

I. General information

NPI: 1932814902
Provider Name (Legal Business Name): BETH VROMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 FOREST AVE
DOWNERS GROVE IL
60515-4608
US

IV. Provider business mailing address

4532 DOUGLAS RD
DOWNERS GROVE IL
60515-3031
US

V. Phone/Fax

Practice location:
  • Phone: 630-805-1482
  • Fax:
Mailing address:
  • Phone: 630-805-1482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.105182
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: