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NPI Code Detail

MEDICARE: ELYSE MARIE WISNIEWSKI

MEDICARE: ELYSE MARIE WISNIEWSKI
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
1101YM0800XMental Health Counselor178020745IL

General Provider Information

NPI Number : 1245176999
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELYSE MARIE WISNIEWSKI
Provider Business Mailing Address
First Line : 5915 N VIRGINIA AVE APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3722
Country : US
Telephone Number : 312-420-3866
Fax Number :
Provider Business Practice Location Address
First Line : 155 N MICHIGAN AVE STE 450
Second Line :
City : CHICAGO
State : IL
Zip : 60601-7939
Country : US
Telephone Number : 708-628-7645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2026
Last Update Date : 04/27/2026

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Directions to “ ELYSE MARIE WISNIEWSKI ” Practice Location

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