Healthcare Provider Details

I. General information

NPI: 1760620041
Provider Name (Legal Business Name): PAULA SEJUT-DVORAK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13246 ROUTE 59 SUITE 100
PLAINFIELD IL
60585
US

IV. Provider business mailing address

13246 ROUTE 59 SUITE 100
PLAINFIELD IL
60585
US

V. Phone/Fax

Practice location:
  • Phone: 815-210-1909
  • Fax:
Mailing address:
  • Phone: 815-210-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.004639
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: