Healthcare Provider Details

I. General information

NPI: 1992677553
Provider Name (Legal Business Name): STEPHANIE VIRUET MSW - INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W BUTTERFIELD RD STE LLB
ELMHURST IL
60126-5024
US

IV. Provider business mailing address

340 W BUTTERFIELD RD STE LLB
ELMHURST IL
60126-5024
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-8919
  • Fax:
Mailing address:
  • Phone: 630-474-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: