Healthcare Provider Details

I. General information

NPI: 1184532137
Provider Name (Legal Business Name): BRIAN MANJARREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E WILLOW AVE
WHEATON IL
60187-5426
US

IV. Provider business mailing address

222 E WILLOW AVE
WHEATON IL
60187-5426
US

V. Phone/Fax

Practice location:
  • Phone: 630-784-4800
  • Fax:
Mailing address:
  • Phone: 630-784-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number150.107689
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: