Healthcare Provider Details

I. General information

NPI: 1548090434
Provider Name (Legal Business Name): PAYTON JUAREZ MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24014 W RENWICK RD STE 103
PLAINFIELD IL
60544-8727
US

IV. Provider business mailing address

24014 W RENWICK RD STE 103
PLAINFIELD IL
60544-8727
US

V. Phone/Fax

Practice location:
  • Phone: 815-517-8467
  • Fax: 815-912-0040
Mailing address:
  • Phone: 815-200-1130
  • Fax: 815-912-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150115850
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: