Healthcare Provider Details

I. General information

NPI: 1689966541
Provider Name (Legal Business Name): CHRISTINE ANNE GESIORSKI MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15010 S RAVINIA AVE STE 15
ORLAND PARK IL
60462-3162
US

IV. Provider business mailing address

15010 S RAVINIA AVE STE 15
ORLAND PARK IL
60462-3162
US

V. Phone/Fax

Practice location:
  • Phone: 708-364-0580
  • Fax:
Mailing address:
  • Phone: 708-364-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.007198
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: