Healthcare Provider Details

I. General information

NPI: 1487543765
Provider Name (Legal Business Name): PREZLEY PIETSZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2252 N MONROE ST
MONROE MI
48162-4254
US

IV. Provider business mailing address

680 JOHN ROLFE DR
MONROE MI
48162-3317
US

V. Phone/Fax

Practice location:
  • Phone: 734-682-5434
  • Fax:
Mailing address:
  • Phone: 734-344-2581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number178018118
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: