Healthcare Provider Details

I. General information

NPI: 1639263635
Provider Name (Legal Business Name): DENNIS ROBERT CIESIELSKI MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 MAIN ST E
MENOMONIE WI
54751-2735
US

IV. Provider business mailing address

1214 16TH AVE E
MENOMONIE WI
54751-3552
US

V. Phone/Fax

Practice location:
  • Phone: 715-232-1116
  • Fax: 715-232-5987
Mailing address:
  • Phone: 715-233-0236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1554-120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: