Provider Demographics
NPI:1831131515
Name:WEGIEREK PSYCHOLOGY CENTER, INC
Entity Type:Organization
Organization Name:WEGIEREK PSYCHOLOGY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:WEGIEREK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-710-8819
Mailing Address - Street 1:3022 N HARLEM AVE
Mailing Address - Street 2:1 NORTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4786
Mailing Address - Country:US
Mailing Address - Phone:708-710-8819
Mailing Address - Fax:
Practice Address - Street 1:3022 N HARLEM AVE
Practice Address - Street 2:1 NORTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4786
Practice Address - Country:US
Practice Address - Phone:708-710-8819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213717Medicare PIN