MEDICARE: MELINDA ANN PIENIAZEK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1073640	IL

General Provider Information

NPI Number	:	1417289794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA ANN PIENIAZEK

Provider Business Mailing Address
First Line	:	4600 WOODWARD AVE
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2631
Country	:	US
Telephone Number	:	773-458-4264
Fax Number	:

Provider Business Practice Location Address
First Line	:	5153 W STRONG ST
Second Line	:	2
City	:	CHICAGO
State	:	IL
Zip	:	60630-2328
Country	:	US
Telephone Number	:	773-458-4264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2010
Last Update Date	:	04/13/2022

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