Provider Demographics
NPI:1871469130
Name:SEWRUK, STEPHEN WILLIAM
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:SEWRUK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 MAJESTIC PRINCE LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-3436
Mailing Address - Country:US
Mailing Address - Phone:630-809-2198
Mailing Address - Fax:
Practice Address - Street 1:1831 BAY SCOTT CIR STE 105
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1115
Practice Address - Country:US
Practice Address - Phone:630-590-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.022158101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health