Provider Demographics
NPI:1023282597
Name:PIETRZAK, SHARON (MA, LCPC, CCDVC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:PIETRZAK
Suffix:
Gender:F
Credentials:MA, LCPC, CCDVC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BILLY CASPER LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-2410
Mailing Address - Country:US
Mailing Address - Phone:708-293-0070
Mailing Address - Fax:708-293-8615
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 621
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:708-293-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional