Provider Demographics
NPI:1154704682
Name:MEGAN E. PIETRUCHA, PSY.D., LLC
Entity type:Organization
Organization Name:MEGAN E. PIETRUCHA, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PIETRUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-609-5855
Mailing Address - Street 1:70 E LAKE ST STE 222
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7649
Mailing Address - Country:US
Mailing Address - Phone:773-609-5855
Mailing Address - Fax:
Practice Address - Street 1:70 E LAKE ST STE 222
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7649
Practice Address - Country:US
Practice Address - Phone:773-609-5855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008783251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health