Provider Demographics
NPI:1770573479
Name:WEGIEREK-SKORUPA, ANNA-MARIA J (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNA-MARIA
Middle Name:J
Last Name:WEGIEREK-SKORUPA
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 1:3022 N HARLEM AVE #1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:708-710-8819
Mailing Address - Fax:773-745-4545
Practice Address - Street 1:3022 N HARLEM AVE #1N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634
Practice Address - Country:US
Practice Address - Phone:708-710-8819
Practice Address - Fax:773-745-4545
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2025-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006917101Y00000X, 103TC0700X
IL071.006917103G00000X, 103T00000X
103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)