Healthcare Provider Details

I. General information

NPI: 1396838843
Provider Name (Legal Business Name): REBECCA EILEEN CIESLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 VETERANS PKWY
MCHENRY IL
60050-8350
US

IV. Provider business mailing address

3101 BULL VALLEY RD
MCHENRY IL
60050-8360
US

V. Phone/Fax

Practice location:
  • Phone: 815-669-2429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801088451
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149013429
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: