Provider Demographics
NPI:1144606385
Name:PESCH, SERENA
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:PESCH
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 1:5215 N RAVENSWOOD AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1670
Mailing Address - Country:US
Mailing Address - Phone:773-654-3179
Mailing Address - Fax:773-973-0353
Practice Address - Street 1:5215 N RAVENSWOOD AVE
Practice Address - Street 2:STE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1670
Practice Address - Country:US
Practice Address - Phone:773-654-3179
Practice Address - Fax:773-973-0353
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0173681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical