Provider Demographics
NPI:1508642521
Name:PIETRZYK, NELL
Entity Type:Individual
Prefix:
First Name:NELL
Middle Name:
Last Name:PIETRZYK
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 1:8222 S 48TH ST
Mailing Address - Street 2:120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5368
Mailing Address - Country:US
Mailing Address - Phone:312-796-4884
Mailing Address - Fax:
Practice Address - Street 1:8222 S 48TH ST
Practice Address - Street 2:120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5368
Practice Address - Country:US
Practice Address - Phone:312-796-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)