Healthcare Provider Details

I. General information

NPI: 1336799220
Provider Name (Legal Business Name): DWIGHT BEJEC MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NAPERVILLE WHEATON RD STE 101
NAPERVILLE IL
60563-1559
US

IV. Provider business mailing address

2582 WARM SPRINGS LN
NAPERVILLE IL
60564-8400
US

V. Phone/Fax

Practice location:
  • Phone: 630-276-7922
  • Fax:
Mailing address:
  • Phone: 630-605-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: