Provider Demographics
NPI:1679919567
Name:PIETRUCHA, MEGAN E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:E
Last Name:PIETRUCHA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MERCHANDISE MART PLZ
Mailing Address - Street 2:FLOOR 4, 4115
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-1103
Mailing Address - Country:US
Mailing Address - Phone:773-609-5855
Mailing Address - Fax:
Practice Address - Street 1:222 MERCHANDISE MART PLZ
Practice Address - Street 2:FLOOR 4, 4115
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-1103
Practice Address - Country:US
Practice Address - Phone:773-609-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical