MEDICARE: RACHEL A PISZCZOR PSY.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	071007429	IL

General Provider Information

NPI Number	:	1417041583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL A PISZCZOR PSY.D.

Provider Business Mailing Address
First Line	:	325 N WELLS ST
Second Line	:	TCSPP-MERCHANDISE MART OFFICE 1355
City	:	CHICAGO
State	:	IL
Zip	:	60654-7024
Country	:	US
Telephone Number	:	703-599-1168
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 MERCHANDISE MART PLZ
Second Line	:	TCSPP-13TH FLOOR-OFFICE 1355
City	:	CHICAGO
State	:	IL
Zip	:	60654-1103
Country	:	US
Telephone Number	:	703-599-1168
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/21/2013

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