Healthcare Provider Details

I. General information

NPI: 1053951459
Provider Name (Legal Business Name): STEPHEN BUHR MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E 1ST ST
ELMHURST IL
60126-2818
US

IV. Provider business mailing address

839 ADDISON AVE
LOMBARD IL
60148-6508
US

V. Phone/Fax

Practice location:
  • Phone: 630-373-0724
  • Fax:
Mailing address:
  • Phone: 630-373-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149017765
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: