MEDICARE: MR. DAVID LEE CIESLA MA, LCPC

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
1	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1083677942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID LEE CIESLA MA, LCPC

Provider Business Mailing Address
First Line	:	4511 N FRANCISCO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3808
Country	:	US
Telephone Number	:	312-208-9499
Fax Number	:	773-539-4637

Provider Business Practice Location Address
First Line	:	55 E WASHINGTON ST
Second Line	:	SUITE 2801
City	:	CHICAGO
State	:	IL
Zip	:	60602-2103
Country	:	US
Telephone Number	:	312-208-9499
Fax Number	:	773-539-4637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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