Healthcare Provider Details

I. General information

NPI: 1164337291
Provider Name (Legal Business Name): GILLIAN TAYLOR PIETRICK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S FERNANDEZ AVE
ARLINGTON HEIGHTS IL
60005-3038
US

IV. Provider business mailing address

1107 S FERNANDEZ AVE
ARLINGTON HEIGHTS IL
60005-3038
US

V. Phone/Fax

Practice location:
  • Phone: 847-278-1851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: