Provider Demographics
NPI:1437783081
Name:WESTFALL, VIRGINIA CLARA
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CLARA
Last Name:WESTFALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N LA GRANGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-5653
Mailing Address - Country:US
Mailing Address - Phone:708-745-5277
Mailing Address - Fax:708-698-5090
Practice Address - Street 1:1023 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1516
Practice Address - Country:US
Practice Address - Phone:708-745-5277
Practice Address - Fax:708-784-9451
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty