| Doctor Name: | ERIN PETRUSIC |
| NPI Number: | 1124432497 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN, PMHNP |
| License Number: | 309007370 |
| Business Practice Address: | 2340 S. Highland Ave, Comprehensive Clinical Services 300 Lombard, IL - 60148 |
| Business Phone Number: | 6302611210 |
| Business Fax Number: | 6302611211 |
| Mailing Address: | 2403 W 32nd Pl, CHICAGO |
| State: | IL |
| Postal Code: | 606086269 |
| Phone Number: | 3122174366 |
| Fax Number: | |
| NPI Enumeration Date: | 06/16/2014 |
| NPI Last Update Date: | 06/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 309007370 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |