Provider Demographics
NPI:1487138327
Name:CIESLAK, VINCENT (MSW, LSW, CADC, CDVP)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:CIESLAK
Suffix:
Gender:M
Credentials:MSW, LSW, CADC, CDVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 WEAVER PKWY STE 100A
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3920
Mailing Address - Country:US
Mailing Address - Phone:630-416-8289
Mailing Address - Fax:
Practice Address - Street 1:4300 WEAVER PKWY STE 100A
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3920
Practice Address - Country:US
Practice Address - Phone:630-416-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health