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General NPI Number Information
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NPI Number | 1245176999
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Entity Type | Individual
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Provider Name | ELYSE MARIE WISNIEWSKI
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Gender | Female
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE STE 450
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City | CHICAGO
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State | IL
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Zip | 60601-7939
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Country | US
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Telephone | 708-628-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 5915 N VIRGINIA AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60659-3722
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Country | US
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Telephone | 312-420-3866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178020745
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License Number State | IL
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